Healthcare Provider Details

I. General information

NPI: 1104874809
Provider Name (Legal Business Name): JANET KRUEGER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 HIGHWAY 6 S STE 100
COLLEGE STATION TX
77845-6176
US

IV. Provider business mailing address

2800 S TEXAS AVE STE 202
BRYAN TX
77802-5361
US

V. Phone/Fax

Practice location:
  • Phone: 979-731-5200
  • Fax: 979-731-5210
Mailing address:
  • Phone: 979-774-2053
  • Fax: 979-776-5914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK1230
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberK1230
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: