Individual
JEREMY R KRUEGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
9205 SW BARNES RD, PORTLAND, OR 97225-6603
(503) 216-2906
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
DO154512
OR
208M00000X
Hospitalist Physician
Primary
DO154512
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500635400
—
OR
01
—
P00973943
RR MEDICARE - PHS
OR
Enumeration date
06/26/2008
Last updated
03/19/2021
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