Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 23602 | NJ |
NPI | 1063623676 |
---|---|
Provider Name | Dr. John Lawrence Krause JR. |
First Address | Bala Cynwyd, PA 19004-2438 |
Second Address | Bala Cynwyd, PA 19004-2438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 08/07/2007 |