Healthcare Provider Details

I. General information

NPI: 1790829992
Provider Name (Legal Business Name): ROY O KROEKER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7081 N MARKS AVE 104 PMB 358
FRESNO CA
93711-0232
US

IV. Provider business mailing address

7081 N MARKS AVE 104 PMB 358
FRESNO CA
93711-0232
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-5565
  • Fax: 559-432-5255
Mailing address:
  • Phone: 559-270-8072
  • Fax: 559-201-9342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE14010
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE14010
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberFZ216Z
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: