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General NPI Number Information
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NPI Number | 1801153119
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Entity Type | Organization
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Legal Business Name | WILLIAM I KRACKE MD PA
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 1705 S POLK ST
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City | AMARILLO
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State | TX
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Zip | 79102-3152
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Country | US
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Telephone | 806-374-6368
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Fax | 806-374-3550
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Provider Business Mailing Address
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Address Line | 1705 S POLK ST
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City | AMARILLO
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State | TX
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Zip | 79102-3152
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Country | US
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Telephone | 806-374-6368
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Fax | 806-374-3550
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM I KRACKE
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Credential | M.D.
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Telephone | 806-374-6368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D3303
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License Number State | TX
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