Healthcare Provider Details

I. General information

NPI: 1326027897
Provider Name (Legal Business Name): RYAN DAVID CRADEUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 WESTLAKE DR
AUSTIN TX
78746-1908
US

IV. Provider business mailing address

2806 WESTLAKE DR
AUSTIN TX
78746-1908
US

V. Phone/Fax

Practice location:
  • Phone: 512-497-7926
  • Fax:
Mailing address:
  • Phone: 512-497-7926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberL9664
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL9664
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: