Provider Demographics
NPI:1841239084
Name:KRUEGER, KURT A (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:A
Last Name:KRUEGER
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 1:5028 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2345
Mailing Address - Country:US
Mailing Address - Phone:850-494-0000
Mailing Address - Fax:816-318-0900
Practice Address - Street 1:5028 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2345
Practice Address - Country:US
Practice Address - Phone:850-494-0000
Practice Address - Fax:816-318-0900
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61086207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD16943Medicare UPIN