Provider Demographics
NPI:1780681114
Name:WUSTERHAUSEN, KRIS H (DO)
Entity Type:Individual
Prefix:MR
First Name:KRIS
Middle Name:H
Last Name:WUSTERHAUSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1517 TEXAS DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6327
Mailing Address - Country:US
Mailing Address - Phone:817-458-3300
Mailing Address - Fax:817-458-3370
Practice Address - Street 1:1517 TEXAS DRIVE
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6327
Practice Address - Country:US
Practice Address - Phone:817-458-3300
Practice Address - Fax:817-458-3370
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144541302Medicaid
137469OtherAETNA
8H0110OtherBCBS
137469OtherAETNA
TXH39682Medicare UPIN