Healthcare Provider Details

I. General information

NPI: 1710977079
Provider Name (Legal Business Name): DONALD E. KROUSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 MAIN ST
WEAVERVILLE CA
96093-0000
US

IV. Provider business mailing address

PO BOX 496084
REDDING CA
96049-6084
US

V. Phone/Fax

Practice location:
  • Phone: 530-623-3735
  • Fax: 530-623-1196
Mailing address:
  • Phone: 530-241-0473
  • Fax: 530-623-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA42613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: