Provider Demographics
NPI:1285611996
Name:KRUPP, GERALD ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ANTHONY
Last Name:KRUPP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:972-715-9976
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1103207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128383006Medicaid
TX128383007Medicaid
TX8EH506OtherBCBS TX
TX050064796OtherRAILROAD
TX128383001Medicaid
TX128383008Medicaid
TX84722KOtherBCBS
TX128383005Medicaid
TX128383009Medicaid
TX84722KMedicare PIN
TX128383005Medicaid
TX128383001Medicaid
TX128383009Medicaid
F27550Medicare UPIN
TX89194KMedicare PIN
TX340058YK6UMedicare PIN