Provider Demographics
NPI:1750373106
Name:KRIEG, DEBRA PEARL (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:PEARL
Last Name:KRIEG
Suffix:
Gender:
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10840 TEXAS HEALTH TRAIL
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6850
Mailing Address - Country:US
Mailing Address - Phone:817-491-0223
Mailing Address - Fax:817-491-0238
Practice Address - Street 1:10840 TEXAS HEALTH TRAIL
Practice Address - Street 2:SUITE 240
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6850
Practice Address - Country:US
Practice Address - Phone:817-491-0223
Practice Address - Fax:817-491-0238
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010798924OtherTAX ID
TX010798924OtherTAX ID
TXI08141Medicare UPIN