Provider Demographics
NPI:1316957525
Name:DEBRA KRIEG, MD PA
Entity type:Organization
Organization Name:DEBRA KRIEG, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:PEARL
Authorized Official - Last Name:KRIEG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:817-491-0223
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 1:4100 HERITAGE TRACE PKWY
Practice Address - Street 2:SUITE 116
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-1306
Practice Address - Country:US
Practice Address - Phone:817-491-0223
Practice Address - Fax:817-491-0238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00797WMedicare UPIN