MEDICARE: DOUGLAS M KRAHN 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	208600000X	Surgery Physician	A64325	CA

General Provider Information

NPI Number	:	1922029677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS M KRAHN M.D.

Provider Business Mailing Address
First Line	:	401 E HIGHLAND AVE STE 252
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-3828
Country	:	US
Telephone Number	:	909-475-8611
Fax Number	:	909-475-8668

Provider Business Practice Location Address
First Line	:	401 E HIGHLAND AVE STE 252
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-3828
Country	:	US
Telephone Number	:	909-475-8611
Fax Number	:	909-475-8668

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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