=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093709404
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUDWIG F KRONER III MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2005
-----------------------------------------------------
Last Update Date | 06/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1204 HILLTOP DR
-----------------------------------------------------
City | ROCK SPRINGS
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82901-5861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-382-5646
-----------------------------------------------------
Fax | 307-382-8467
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1204 HILLTOP DR SUITE 102
-----------------------------------------------------
City | ROCK SPRINGS
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82901-5861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-382-5646
-----------------------------------------------------
Fax | 307-382-8467
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 3152A
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 11130
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------