Healthcare Provider Details

I. General information

NPI: 1508219569
Provider Name (Legal Business Name): FREDERICK J KRUGER DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 E HERNDON AVE STE 104
FRESNO CA
93720-2990
US

IV. Provider business mailing address

530 E HERNDON AVE STE 104
FRESNO CA
93720-2990
US

V. Phone/Fax

Practice location:
  • Phone: 559-447-9040
  • Fax:
Mailing address:
  • Phone: 559-447-9040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. FREDERICK JULIAN KRUGER
Title or Position: OWNER/PODIATRIST
Credential: D.P.M.
Phone: 559-447-9040