Provider Demographics
NPI:1760634364
Name:JOHN M KROENER A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JOHN M KROENER A MEDICAL CORPORATION
Other - Org Name:JOHN M. KROENER, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KROENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-724-5352
Mailing Address - Street 1:3998 VISTA WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4500
Mailing Address - Country:US
Mailing Address - Phone:760-724-5352
Mailing Address - Fax:760-724-5447
Practice Address - Street 1:3998 VISTA WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4500
Practice Address - Country:US
Practice Address - Phone:760-724-5352
Practice Address - Fax:760-724-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35262174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG35262Medicare PIN