MEDICARE: DR. ROSS T KRUEGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	21320	FL

General Provider Information

NPI Number	:	1649243189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSS T KRUEGER M.D.

Provider Business Mailing Address
First Line	:	1801 BARRS ST
Second Line	:	SUITE 605
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4732
Country	:	US
Telephone Number	:	904-387-4424
Fax Number	:	904-387-4423

Provider Business Practice Location Address
First Line	:	1801 BARRS ST
Second Line	:	SUITE 605
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4732
Country	:	US
Telephone Number	:	904-387-4424
Fax Number	:	904-387-4423

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	07/09/2007

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