Provider Demographics
NPI:1700811387
Name:KRUM, THEODORE JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:JOSEPH
Last Name:KRUM
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 1:811 W I 20 STE 212
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5873
Mailing Address - Country:US
Mailing Address - Phone:214-942-3100
Mailing Address - Fax:469-399-0355
Practice Address - Street 1:811 W I 20 STE 212
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5873
Practice Address - Country:US
Practice Address - Phone:214-942-3100
Practice Address - Fax:469-399-0355
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2517207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098762003Medicaid
TX098762006OtherMEDICAID OTHER
TX098762009Medicaid
TX098762007Medicaid
TX098762005OtherMEDICAID TPI
TX098762006OtherMEDICAID OTHER
TX8K8987Medicare PIN
TX098762007Medicaid
TX8K8987Medicare PIN