Provider Demographics
NPI:1730294620
Name:KRUEGER, DAVID W (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 BAILEY LN STE 200
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-8523
Mailing Address - Country:US
Mailing Address - Phone:239-262-1721
Mailing Address - Fax:239-262-1045
Practice Address - Street 1:3200 BAILEY LN STE 200
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-8523
Practice Address - Country:US
Practice Address - Phone:239-262-1721
Practice Address - Fax:239-262-1045
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87699208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271670400Medicaid
FLH91553Medicare UPIN
FL271670400Medicaid