Provider Demographics
NPI:1568444107
Name:PEPPER, KRAIG ROBERT (DO PA)
Entity Type:Individual
Prefix:DR
First Name:KRAIG
Middle Name:ROBERT
Last Name:PEPPER
Suffix:
Gender:M
Credentials:DO PA
Other - Prefix:DR
Other - First Name:KRAIG
Other - Middle Name:ROBERT
Other - Last Name:PEPPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO PA
Mailing Address - Street 1:6930 HARRIS PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4272
Mailing Address - Country:US
Mailing Address - Phone:817-632-0020
Mailing Address - Fax:817-632-0022
Practice Address - Street 1:6930 HARRIS PKWY STE 130
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4272
Practice Address - Country:US
Practice Address - Phone:817-632-0020
Practice Address - Fax:817-632-0022
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1060207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203808502Medicaid
PA101210471Medicaid
PA101210471Medicaid
TXI26932Medicare UPIN
PAI29632Medicare UPIN
PA101210471Medicaid