Healthcare Provider Details

I. General information

NPI: 1205072469
Provider Name (Legal Business Name): KRANTZ RADIOLOGY - NACOGDOCHES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 NE STALLINGS DR
NACOGDOCHES TX
75965-1254
US

IV. Provider business mailing address

800 ROCKMEAD DR 208
KINGWOOD TX
77339-2112
US

V. Phone/Fax

Practice location:
  • Phone: 936-569-9481
  • Fax:
Mailing address:
  • Phone: 281-359-7788
  • Fax: 281-359-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY KRANTZ
Title or Position: PRESIDENT
Credential: D.O.
Phone: 281-359-7788