Provider Demographics
NPI:1942263157
Name:MARK MALOY KRAUSE
Entity Type:Organization
Organization Name:MARK MALOY KRAUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:MALOY
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:830-798-2400
Mailing Address - Street 1:PO BOX 1967
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-2681
Mailing Address - Country:US
Mailing Address - Phone:830-798-2400
Mailing Address - Fax:830-798-2411
Practice Address - Street 1:503 HWY 1431
Practice Address - Street 2:STE 101
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-5251
Practice Address - Country:US
Practice Address - Phone:830-798-2400
Practice Address - Fax:830-798-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1321213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0061CMOtherBCBS
TX092733701Medicaid
TX092733701Medicaid
TX0061CMOtherBCBS
TXU64741Medicare UPIN