Provider Demographics
NPI:1063033629
Name:KRAAN, DAVID JON (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JON
Last Name:KRAAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5921 MACKEREL DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-7633
Mailing Address - Country:US
Mailing Address - Phone:254-541-2278
Mailing Address - Fax:
Practice Address - Street 1:721 SOUTHEAST PKWY
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3634
Practice Address - Country:US
Practice Address - Phone:817-270-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU6275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine