Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | DR.0055335 | CO |
NPI | 1093031940 |
---|---|
Provider Name | Jonathan Ray Kruger |
First Address | Fayetteville, AR 72702-1523 |
Second Address | Fayetteville, AR 72703-4057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2010 |
Last Update Date | 17/12/2021 |