Basic Information
| Provider Information | |||||||||
| NPI: | 1215091368 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KRUGER CLINIC ORTHOPAEDICS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21600 HWY 99 STE 150 | ||||||||
| Address2: | |||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257742636 | ||||||||
| FaxNumber: | 4257742688 | ||||||||
| Practice Location | |||||||||
| Address1: | 21600 HWY 99 STE 150 | ||||||||
| Address2: | |||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257742636 | ||||||||
| FaxNumber: | 4257742636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 12/12/2011 | ||||||||
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| AuthorizedOfficialLastName: | DEGAN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 4257742636 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | 601850391 | WA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.