Provider Demographics
NPI:1114918224
Name:KRAUS, ALAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:J
Last Name:KRAUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 381721
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-1721
Mailing Address - Country:US
Mailing Address - Phone:901-754-3365
Mailing Address - Fax:901-754-2768
Practice Address - Street 1:2028 W POPLAR AVE STE 102
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0618
Practice Address - Country:US
Practice Address - Phone:901-754-3365
Practice Address - Fax:901-754-2768
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14829207LP2900X
MS18045207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3004339Medicaid
MS720000018Medicaid
3004339Medicare ID - Type Unspecified
MS720000018Medicaid