Healthcare Provider Details

I. General information

NPI: 1427582345
Provider Name (Legal Business Name): RICHARD JOHN KRETSCHMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#223-8604 GATEWAY BLVD
EDMONTON ALBERTA
T6E4B6
CA

IV. Provider business mailing address

157 KLUGE TRAIL
ROCKPORT TX
78382
US

V. Phone/Fax

Practice location:
  • Phone: 250-702-5702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ3906
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberQ3906
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberQ3906
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: