Healthcare Provider Details

I. General information

NPI: 1972720381
Provider Name (Legal Business Name): JOHN ROBERT KRIEG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 BELLE CHASSE HWY. B-2
GRETNA LA
70056
US

IV. Provider business mailing address

2600 BELLE CHASSE HWY. B-2
GRETNA LA
70056
US

V. Phone/Fax

Practice location:
  • Phone: 504-349-2273
  • Fax: 504-903-4569
Mailing address:
  • Phone: 504-349-2273
  • Fax: 504-903-4569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD205462
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number07117R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: