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General NPI Number Information
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NPI Number | 1902950256
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Entity Type | Organization
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Legal Business Name | CORY KRUEGER MD PLC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 305 S WILLARD ST
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4127
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Country | US
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Telephone | 928-634-7000
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Fax | 928-634-5649
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Provider Business Mailing Address
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Address Line | 305 SOUTH WILLARD STREET
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City | COTTONWOOD
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State | AZ
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Zip | 86326
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Country | US
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Telephone | 928-634-7000
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Fax | 928-634-5649
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Authorized Official
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Title or Position | OWNER
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Name | CORY KRUEGER
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Credential | MD
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Telephone | 19286347000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 36238
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License Number State | AZ
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