Provider Demographics
NPI:1740283019
Name:HOWARD, KRIS (MD)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:HOWARD
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 1:8141 DORADO DRIVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765
Mailing Address - Country:US
Mailing Address - Phone:432-563-3113
Mailing Address - Fax:432-563-4206
Practice Address - Street 1:8141 DORADO DRIVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765
Practice Address - Country:US
Practice Address - Phone:432-563-3113
Practice Address - Fax:432-563-4206
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0466207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123135904Medicaid
TX8AJ715OtherBCBS
TX8AJ715OtherBCBS
TX8F9015Medicare PIN
TX00G30AMedicare PIN