Provider Demographics
NPI:1528001211
Name:KREISLE, JAMES EDWIN JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWIN
Last Name:KREISLE
Suffix:JR
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 1:1600 W. 38TH ST. #321
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-454-5716
Mailing Address - Fax:512-454-6276
Practice Address - Street 1:1600 W. 38TH ST. #321
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-454-5716
Practice Address - Fax:512-454-6276
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK76112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8718MOMedicare PIN
TXB24113Medicare UPIN