Individual
ELLISA KRUMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 702-1204
Mailing address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 702-1204
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
45018
TN
207Q00000X
Family Medicine Physician
LL28867
SC
207Q00000X
Family Medicine Physician
Primary
Q2699
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1513688
—
TN
Enumeration date
11/01/2006
Last updated
06/06/2017
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