Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 18589 | OH |
NPI | 1023075942 |
---|---|
Provider Name | Dr. Richard D Kruer JR. |
First Address | Fort Thomas, KY 41075-1942 |
Second Address | Goldsboro, NC 27534-1747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 06/11/2019 |