Healthcare Provider Details

I. General information

NPI: 1538131024
Provider Name (Legal Business Name): JOHN KROGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 FRANKLIN ST
RUMFORD ME
04276-2104
US

IV. Provider business mailing address

430 FRANKLIN ST
RUMFORD ME
04276-2104
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-5709
  • Fax:
Mailing address:
  • Phone: 207-795-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number013593
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: