MEDICARE: DR. JAMES DOUGLAS KRETLOW M.D., PH.D.

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	208200000X	Plastic Surgery Physician	BP10039710	TX

General Provider Information

NPI Number	:	1396032629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DOUGLAS KRETLOW M.D., PH.D.

Provider Business Mailing Address
First Line	:	2102 MACARTHUR ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2104
Country	:	US
Telephone Number	:	713-527-9375
Fax Number	:

Provider Business Practice Location Address
First Line	:	2102 MACARTHUR ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2104
Country	:	US
Telephone Number	:	713-527-9375
Fax Number	:

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

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	07/07/2011

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