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General NPI Number Information
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NPI Number | 1093177321
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Entity Type | Individual
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Provider Name | KEVIN KRUGHOFF
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Gender | Male
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 2400 HARTMAN LN
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City | SPRINGFIELD
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State | OR
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Zip | 97477-1118
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Country | US
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Telephone | 541-736-2934
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Fax |
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Provider Business Mailing Address
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Address Line | 2876 LONGFELLOW PL APT 251
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City | EUGENE
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State | OR
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Zip | 97408-7465
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Country | US
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Telephone | 720-317-5902
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 2021-00685
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License Number State | NC
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Taxonomy #2
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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 #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD209558
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License Number State | OR
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