Provider Demographics
NPI:1831540863
Name:KRAUSE, JOHN KIRBY JR (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KIRBY
Last Name:KRAUSE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 HIGHLANDS PLAZA DR W
Mailing Address - Street 2:APT 510
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1303
Mailing Address - Country:US
Mailing Address - Phone:314-853-3141
Mailing Address - Fax:
Practice Address - Street 1:1031 HIGHLANDS PLAZA DR W
Practice Address - Street 2:APT 510
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1303
Practice Address - Country:US
Practice Address - Phone:314-853-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016022708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine