Provider Demographics
NPI:1902876972
Name:MYERS, KRISS E (MD)
Entity Type:Individual
Prefix:
First Name:KRISS
Middle Name:E
Last Name:MYERS
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 1:141 INDUSTRIAL AVE
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-2901
Mailing Address - Country:US
Mailing Address - Phone:817-444-3231
Mailing Address - Fax:817-444-3234
Practice Address - Street 1:141 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-2901
Practice Address - Country:US
Practice Address - Phone:817-444-3231
Practice Address - Fax:817-444-3234
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138789614Medicaid
TX138789603Medicaid
TX8L27239Medicare PIN
TX82G721Medicare ID - Type Unspecified
TX138789614Medicaid