Provider Demographics
NPI:1851364442
Name:KRUEGER, SCOTT L (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 422
Mailing Address - Street 2:BX 1011
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09067-0422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3334 CAPITAL MEDICAL BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8405
Practice Address - Country:US
Practice Address - Phone:850-219-1932
Practice Address - Fax:850-219-1881
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103617363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicare ID - Type Unspecified