Provider Demographics
NPI:1598842403
Name:KRAVEN, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:KRAVEN
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 1:702 RIVA RIDGE
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-8267
Mailing Address - Country:US
Mailing Address - Phone:972-941-6447
Mailing Address - Fax:972-941-6448
Practice Address - Street 1:702 RIVA RIDGE
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-8267
Practice Address - Country:US
Practice Address - Phone:972-981-6448
Practice Address - Fax:972-941-6448
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ12872083P0011X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C63287Medicare UPIN
TX609887Medicare ID - Type Unspecified