Individual
DR. BENJAMIN JOHN KROG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 531-4500
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
BP1-006254
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
337461301
—
TX
01
—
3836532114
MYUTMB 3836532114-COMMERCIAL NUMBER
—
01
—
752616977042
TRICARE
TX
01
—
8EG496
BCBS
TX
Enumeration date
06/14/2007
Last updated
01/26/2015
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