Individual
JOHN KROGH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
303 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2709
(386) 425-2285
(386) 425-7522
Mailing address
PO BOX 732901, DALLAS, TX 75373-2901
(386) 226-4590
(386) 226-3371
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-05125
NC
363A00000X
Physician Assistant
Primary
PA9108749
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-05125
NORTH CAROLINA MEDICAL BOARD
NC
Enumeration date
07/15/2014
Last updated
10/07/2015
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