Provider Demographics
NPI:1154389161
Name:KRALL, SCOTT P (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:P
Last Name:KRALL
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 1:1533 S BROWNLEE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3131
Mailing Address - Country:US
Mailing Address - Phone:361-884-2242
Mailing Address - Fax:361-884-2243
Practice Address - Street 1:1533 S BROWNLEE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404
Practice Address - Country:US
Practice Address - Phone:361-884-2242
Practice Address - Fax:512-291-5657
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004523207P00000X
TXJ2139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000695801Medicaid
DE0000695801Medicaid