Healthcare Provider Details

I. General information

NPI: 1386690667
Provider Name (Legal Business Name): GERALD F KRONK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17601 B HWY
BOONVILLE MO
65233-2839
US

IV. Provider business mailing address

PO BOX 7687
COLUMBIA MO
65205-7687
US

V. Phone/Fax

Practice location:
  • Phone: 660-882-5616
  • Fax: 816-882-7073
Mailing address:
  • Phone: 573-882-2259
  • Fax: 573-884-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD30446
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: