Healthcare Provider Details

I. General information

NPI: 1093709404
Provider Name (Legal Business Name): LUDWIG F KRONER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 HILLTOP DR
ROCK SPRINGS WY
82901-5861
US

IV. Provider business mailing address

1204 HILLTOP DR SUITE 102
ROCK SPRINGS WY
82901-5861
US

V. Phone/Fax

Practice location:
  • Phone: 307-382-5646
  • Fax: 307-382-8467
Mailing address:
  • Phone: 307-382-5646
  • Fax: 307-382-8467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3152A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number11130
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: