Provider Demographics
NPI:1235178047
Name:KRAUS, MATHEW T (MD)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:T
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 1:1059 E HIGHWAY 11 E
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-4910
Mailing Address - Country:US
Mailing Address - Phone:865-375-6005
Mailing Address - Fax:865-471-0244
Practice Address - Street 1:1059 E HIGHWAY 11 E
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-4910
Practice Address - Country:US
Practice Address - Phone:865-375-6005
Practice Address - Fax:865-471-0244
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40967208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI32314Medicare UPIN
10311I6476Medicare PIN