Individual
JOHN SEVERIN KRISTOFERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3325 MEDPARK DR, DENTON, TX 76210
(940) 382-6757
(940) 383-1894
Mailing address
3325 MEDPARK DR, DENTON, TX 76210-6898
(940) 382-6757
(940) 383-1894
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
F6842
TX
207X00000X
Orthopaedic Surgery Physician
TXF6842
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0020KD
BCBS
TX
01
—
0474740001
MEDICARE SUPPLIER NUMBER
TX
01
—
200002820
PALMETTO GBA
TX
01
—
8J2030
BCBS
TX
Enumeration date
09/15/2005
Last updated
08/20/2018
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