Healthcare Provider Details

I. General information

NPI: 1801960364
Provider Name (Legal Business Name): JADRANKO CORAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E 12TH ST SUITE 101
AUSTIN TX
78701-1954
US

IV. Provider business mailing address

1601 RIO GRANDE ST SUITE 340
AUSTIN TX
78701-1137
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-9650
  • Fax: 512-324-9651
Mailing address:
  • Phone: 512-324-8960
  • Fax: 512-324-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL0778
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: