Healthcare Provider Details

I. General information

NPI: 1316251960
Provider Name (Legal Business Name): ROY O. KROEKER, DPM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7081 N MARKS AVE 104 PMB 358 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:
Mailing address:
  • Phone: 559-432-5565
  • Fax: 559-462-5255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE14010
License Number StateCA

VIII. Authorized Official

Name: DR. ROY O KROEKER
Title or Position: PRESIDENT/DOCTOR
Credential: DPM
Phone: 559-432-5565