Provider Demographics
NPI:1093746984
Name:KRUSE, EDWARD J (DO)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:KRUSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 WALTON WAY
Mailing Address - Street 2:STE 1400
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2602
Mailing Address - Country:US
Mailing Address - Phone:706-828-8403
Mailing Address - Fax:
Practice Address - Street 1:3804 S JACKSON RD STE 1
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6681
Practice Address - Country:US
Practice Address - Phone:956-296-3001
Practice Address - Fax:956-296-3000
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0580552086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology