Healthcare Provider Details

I. General information

NPI: 1740609288
Provider Name (Legal Business Name): ANTHONY RAY ARREDONDO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MUELLER BLVD
AUSTIN TX
78723-3079
US

IV. Provider business mailing address

4900 MUELLER BLVD
AUSTIN TX
78723-3079
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-0150
  • Fax:
Mailing address:
  • Phone: 512-324-0093
  • Fax: 512-422-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR2272
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberR2272
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: