Healthcare Provider Details

I. General information

NPI: 1295768257
Provider Name (Legal Business Name): NORMAN W KROUSKOP JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 01/12/2020
Certification Date: 01/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 STATE HIGHWAY 11 W
PITTSBURG TX
75686-8042
US

IV. Provider business mailing address

4710 STATE HIGHWAY 11 W
PITTSBURG TX
75686-8042
US

V. Phone/Fax

Practice location:
  • Phone: 214-912-6050
  • Fax:
Mailing address:
  • Phone: 214-912-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE1003
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: