Provider Demographics
NPI:1992893408
Name:KRUEGER, JAMES JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JEROME
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-0749
Mailing Address - Country:US
Mailing Address - Phone:562-424-6040
Mailing Address - Fax:562-427-2565
Practice Address - Street 1:701 E 28TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2759
Practice Address - Country:US
Practice Address - Phone:562-424-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA045160207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX72340Medicaid
CA00AX72340Medicaid
CAWA45160BMedicare PIN