Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 32655 | TX |
Y | 103T00000X | Psychologist | 32655 | TX |
NPI | 1013183433 |
---|---|
Provider Name | Dr. Douglas Eugene Krug |
First Address | De Leon, TX 76444-1946 |
Second Address | Stephenville, TX 76401-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2008 |
Last Update Date | 19/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
194646901 | (05) | TX |
613275 | (02) |