Provider Demographics
NPI:1386749422
Name:KRUGER, PAUL SPENCER (M D)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:SPENCER
Last Name:KRUGER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EATON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-1124
Mailing Address - Country:US
Mailing Address - Phone:315-824-2651
Mailing Address - Fax:315-824-4011
Practice Address - Street 1:10 EATON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-1124
Practice Address - Country:US
Practice Address - Phone:315-824-2651
Practice Address - Fax:315-824-4011
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117005207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00458508Medicaid
NY00458508Medicaid
NYB81258Medicare UPIN