Provider Demographics
NPI:1073701181
Name:GREG KRENEK, M.D., P.A.
Entity Type:Organization
Organization Name:GREG KRENEK, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:KRENEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-756-0668
Mailing Address - Street 1:503 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2928
Mailing Address - Country:US
Mailing Address - Phone:936-756-0668
Mailing Address - Fax:936-756-7787
Practice Address - Street 1:503 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2928
Practice Address - Country:US
Practice Address - Phone:936-756-0668
Practice Address - Fax:936-756-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6529207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0039MBOtherBLUE CROSS BLUE SHIELD
TX0039MBOtherBLUE CROSS BLUE SHIELD
TXF95650Medicare UPIN