Provider Demographics
NPI:1154345502
Name:KRUEGER, RONALD L (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 E 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-4006
Mailing Address - Country:US
Mailing Address - Phone:509-954-5219
Mailing Address - Fax:
Practice Address - Street 1:1712 E 34TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-4006
Practice Address - Country:US
Practice Address - Phone:509-954-5219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020950208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1017334Medicaid
000349203Medicare ID - Type Unspecified
WA1017334Medicaid