Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | SC003511L | PA |
NPI | 1003879149 |
---|---|
Provider Name | Dr. Paul G Krouse |
First Address | Latrobe, PA 15650-0030 |
Second Address | Latrobe, PA 15650-1921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 07/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001210790003 | (05) | PA |
U02253 | (02) | PA |