Provider Demographics
NPI:1770216533
Name:KRIEGER, GARY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ROBERT
Last Name:KRIEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8348 OURAY DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-8815
Mailing Address - Country:US
Mailing Address - Phone:303-809-4494
Mailing Address - Fax:
Practice Address - Street 1:8348 OURAY DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-8815
Practice Address - Country:US
Practice Address - Phone:303-809-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00257922083T0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical ToxicologyGroup - Single Specialty