Provider Demographics
NPI:1740211192
Name:KRUEGER, WESLEY WILLIAM (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:WILLIAM
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 S CYNTHIA ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1294
Mailing Address - Country:US
Mailing Address - Phone:956-687-7896
Mailing Address - Fax:956-994-9694
Practice Address - Street 1:2632 BROADWAY ST
Practice Address - Street 2:SUITE 201-202 SOUTH BUILDING
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1021
Practice Address - Country:US
Practice Address - Phone:210-697-0880
Practice Address - Fax:210-697-0888
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4463207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134986201Medicaid
TXB24133Medicare UPIN
TX134986201Medicaid