Healthcare Provider Details

I. General information

NPI: 1790753077
Provider Name (Legal Business Name): JEFFREY S KRANTZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S FM 51
DECATUR TX
76234-3702
US

IV. Provider business mailing address

800 ROCKMEAD DR S:210
KINGWOOD TX
77339
US

V. Phone/Fax

Practice location:
  • Phone: 281-359-7788
  • Fax: 281-359-7888
Mailing address:
  • Phone: 281-359-7788
  • Fax: 281-359-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number3771
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number3771
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberJ7343
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: