MEDICARE: MR. PETER KENNEDY KRONE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	L4507	TX

General Provider Information

NPI Number	:	1164429288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER KENNEDY KRONE MD

Provider Business Mailing Address
First Line	:	1208 MEDICAL PLAZA CT
Second Line	:
City	:	GRANBURY
State	:	TX
Zip	:	76048-5653
Country	:	US
Telephone Number	:	817-579-7562
Fax Number	:	817-579-7592

Provider Business Practice Location Address
First Line	:	1208 MEDICAL PLAZA CT
Second Line	:
City	:	GRANBURY
State	:	TX
Zip	:	76048-5653
Country	:	US
Telephone Number	:	817-579-7562
Fax Number	:	817-579-7592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	09/11/2020

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