Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A146997 | CA |
NPI | 1003201666 |
---|---|
Provider Name | Dr. Justin David Krogue |
First Address | San Francisco, CA 94143-2203 |
Second Address | San Francisco, CA 94143-2203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2015 |
Last Update Date | 14/05/2020 |