Basic Information
| Provider Information | |||||||||
| NPI: | 1497736573 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRUIDENIER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 LILLY RD NE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985065195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604138191 | ||||||||
| FaxNumber: | 3604138110 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 LILLY RD NE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985065195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604138191 | ||||||||
| FaxNumber: | 3604138110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 08/04/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MD00019766 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | AK9526015 | 01 | WA | DEA NUMBER | OTHER | MD00019766 | 01 | WA | MD LISENCE | OTHER |