Provider Demographics
NPI:1295781383
Name:KRIEGER, CHARLES W JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:KRIEGER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1051 GAUSE BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2993
Mailing Address - Country:US
Mailing Address - Phone:985-280-3664
Mailing Address - Fax:985-280-3683
Practice Address - Street 1:1051 GAUSE BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-280-3664
Practice Address - Fax:985-280-3683
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-08-29
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Provider Licenses
StateLicense IDTaxonomies
LA010738207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1801020433OtherNPI SMH PHYSICIAN NETWORK
LA173209500OtherACS, DEPT. OF LABOR
LA4120027OtherAETNA
LA720778314OtherTRICARE
LA4120027OtherAETNA
LAB64442Medicare UPIN