Healthcare Provider Details

I. General information

NPI: 1114918224
Provider Name (Legal Business Name): ALAN J KRAUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 W POPLAR AVE STE 102
COLLIERVILLE TN
38017-0618
US

IV. Provider business mailing address

PO BOX 381721
GERMANTOWN TN
38183-1721
US

V. Phone/Fax

Practice location:
  • Phone: 901-754-3365
  • Fax: 901-754-2768
Mailing address:
  • Phone: 901-754-3365
  • Fax: 901-754-2768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number14829
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number18045
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: