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General NPI Number Information
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NPI Number | 1427198811
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Entity Type | Organization
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Legal Business Name | JASON A KRUPP MD PC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5930 ROYAL LN SUITE E #236
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City | DALLAS
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State | TX
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Zip | 75230-3849
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Country | US
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Telephone | 214-701-7608
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Fax |
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Provider Business Mailing Address
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Address Line | 4351 E LOHMAN AVE SUITE 204
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City | LAS CRUCES
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State | NM
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Zip | 88011-8259
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Country | US
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Telephone | 214-701-7608
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON ADAM KRUPP
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Credential | MD
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Telephone | 214-701-7607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MD20040216
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License Number State | NM
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