Provider Demographics
NPI:1790753077
Name:KRANTZ, JEFFREY S (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:KRANTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROCKMEAD DR
Mailing Address - Street 2:S:210
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339
Mailing Address - Country:US
Mailing Address - Phone:281-359-7788
Mailing Address - Fax:281-359-7888
Practice Address - Street 1:2000 S FM 51
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3702
Practice Address - Country:US
Practice Address - Phone:281-359-7788
Practice Address - Fax:281-359-7888
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37712085N0700X, 2085R0202X
TXJ73432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100189600AMedicaid
TX147609505Medicaid
TX147609504Medicaid
G18636Medicare UPIN
OKP00427189Medicare PIN
TXP00613459Medicare PIN
TX147609505Medicaid
TX8F2922Medicare PIN
TXP00304264Medicare PIN
OK246719801Medicare PIN