Provider Demographics
NPI:1629076138
Name:PETER K KRONE MD, PA
Entity Type:Organization
Organization Name:PETER K KRONE MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:KENNEDY
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-579-7562
Mailing Address - Street 1:1308 PALUXY RD
Mailing Address - Street 2:STE 305
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5689
Mailing Address - Country:US
Mailing Address - Phone:817-579-7562
Mailing Address - Fax:817-579-7592
Practice Address - Street 1:1308 PALUXY RD
Practice Address - Street 2:STE 305
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5689
Practice Address - Country:US
Practice Address - Phone:817-579-7562
Practice Address - Fax:817-579-7592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H16050Medicare UPIN
00803TMedicare ID - Type Unspecified