Provider Demographics
NPI:1487885414
Name:KRANK, EUGENE MARVIN JR (DPM)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:MARVIN
Last Name:KRANK
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4358 W 136TH ST
Mailing Address - Street 2:#D
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-7127
Mailing Address - Country:US
Mailing Address - Phone:310-219-3339
Mailing Address - Fax:
Practice Address - Street 1:4358 W 136TH ST
Practice Address - Street 2:#D
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-7127
Practice Address - Country:US
Practice Address - Phone:310-219-3339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-08
Last Update Date:2009-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD155R213ES0131X
VA0103000955213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0103000955OtherSTATE LICENSE
LAPD155ROtherSTATE LICENSE
LAPD155ROtherSTATE LICENSE