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General NPI Number Information
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NPI Number | 1053979674
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Entity Type | Individual
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Provider Name | STEPHEN ROBERT KRUGER DO
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Gender | Male
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 445 W EATON AVE
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City | TRACY
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State | CA
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Zip | 95376-3420
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Country | US
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Telephone | 209-830-4075
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 255228
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City | SACRAMENTO
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State | CA
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Zip | 95865-5228
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 315634
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MB11240400
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A22402
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License Number State | CA
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