Healthcare Provider Details

I. General information

NPI: 1215091368
Provider Name (Legal Business Name): KRUGER CLINIC ORTHOPAEDICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21600 HWY 99 STE 150
EDMONDS WA
98026
US

IV. Provider business mailing address

21600 HWY 99 STE 150
EDMONDS WA
98026
US

V. Phone/Fax

Practice location:
  • Phone: 425-774-2636
  • Fax: 425-774-2636
Mailing address:
  • Phone: 425-774-2636
  • Fax: 425-774-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number601850391
License Number StateWA

VIII. Authorized Official

Name: THOMAS J DEGAN
Title or Position: MEDICAL DOCTOR
Credential: M.D
Phone: 425-774-2636