Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | MD016760E | PA |
N | 2081P2900X | Pain Medicine | MD0167760E | PA |
NPI | 1174545560 |
---|---|
Provider Name | John J Kraus |
First Address | Malvern, PA 19355-3311 |
Second Address | Malvern, PA 19355-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00305801 | (05) | DE |
C08044 | (02) |