Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 0810001170 | VA |
NPI | 1467478321 |
---|---|
Provider Name | Dr. Jeffrey S Kreutzer |
First Address | Richmond, VA 23291-1734 |
Second Address | Richmond, VA 23298-0677 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7767471 | (05) | VA |
R88724 | (02) |