Provider Demographics
NPI:1043614316
Name:JAMES P. KRIEG M.D., MED CORP
Entity type:Organization
Organization Name:JAMES P. KRIEG M.D., MED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRIEG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-672-1911
Mailing Address - Street 1:29826 HAUN RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-6546
Mailing Address - Country:US
Mailing Address - Phone:951-672-1911
Mailing Address - Fax:951-672-8406
Practice Address - Street 1:29826 HAUN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-6546
Practice Address - Country:US
Practice Address - Phone:951-672-1911
Practice Address - Fax:951-672-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52048261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care