Provider Demographics
NPI:1013183433
Name:KRUG, DOUGLAS EUGENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:EUGENE
Last Name:KRUG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:DE LEON
Mailing Address - State:TX
Mailing Address - Zip Code:76444-1946
Mailing Address - Country:US
Mailing Address - Phone:254-979-1102
Mailing Address - Fax:254-893-5260
Practice Address - Street 1:216 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-4216
Practice Address - Country:US
Practice Address - Phone:254-979-1102
Practice Address - Fax:254-893-5260
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32655103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194646901Medicaid
613275Medicare UPIN