Provider Demographics
NPI:1205944782
Name:KREUL, BRIAN (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:KREUL
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 1:3200 HILLCREST PARK DR 200
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7686
Mailing Address - Country:US
Mailing Address - Phone:541-773-6700
Mailing Address - Fax:866-430-4035
Practice Address - Street 1:2959 SISKIYOU BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8131
Practice Address - Country:US
Practice Address - Phone:541-773-2110
Practice Address - Fax:541-734-7368
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28013208200000X, 2086S0122X
ORMD2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1205944782OtherNPI
OR1205944782OtherNPI