Provider Demographics
NPI:1740712785
Name:KROGER, JOHN RUSSELL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RUSSELL
Last Name:KROGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8116
Mailing Address - Fax:614-293-5315
Practice Address - Street 1:1462 MARION WALDO RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-7422
Practice Address - Country:US
Practice Address - Phone:740-389-5418
Practice Address - Fax:740-389-5410
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2022-07-25
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Provider Licenses
StateLicense IDTaxonomies
OH35141469207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0442188Medicaid