MEDICARE: DR. CARYN DENISE KRENEK 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	208000000X	Pediatrics Physician	J5170	TX

General Provider Information

NPI Number	:	1912234345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARYN DENISE KRENEK MD

Provider Business Mailing Address
First Line	:	2029 W BEAUREGARD AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-3812
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 W BEAUREGARD AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-3883
Country	:	US
Telephone Number	:	325-944-8900
Fax Number	:

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

Provider Enumeration Date	:	11/05/2009
Last Update Date	:	11/05/2009

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