Provider Demographics
NPI:1740849140
Name:KROEKER, BRUCE SAMUEL (DPM)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:SAMUEL
Last Name:KROEKER
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 FM 2920 RD STE N
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3590
Mailing Address - Country:US
Mailing Address - Phone:281-444-6300
Mailing Address - Fax:832-375-1247
Practice Address - Street 1:2616 FM 2920 RD STE N
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3590
Practice Address - Country:US
Practice Address - Phone:281-444-6300
Practice Address - Fax:832-375-1247
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3171213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty