Individual
MR. KEVIN LOUIS KRUENEGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
555 BLACK OAK DR, MEDFORD, OR 97504-8447
(541) 789-8176
(541) 789-4806
Mailing address
2825 E BARNETT RD, MEDFORD, OR 97504-8332
(541) 789-8176
(541) 789-4806
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
005820
GA
363A00000X
Physician Assistant
Primary
196530
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003129392A
—
GA
Enumeration date
04/21/2010
Last updated
02/13/2020
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