MEDICARE: DR. PENNER T SCHRAUDENBACH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	N1132	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01366412	OTHER	TX	RAILROAD MEDICARE
2	TXB120824	OTHER	TX	MEDICARE HARRIS
6	TXB120811	OTHER	TX	MEDICARE MONTGOMERY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1700816428	OTHER	TX	NPI
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477738409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PENNER T SCHRAUDENBACH MD

Provider Business Mailing Address
First Line	:	PO BOX 911230
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-1230
Country	:	US
Telephone Number	:	972-997-8000
Fax Number	:	972-234-0813

Provider Business Practice Location Address
First Line	:	506 GRAHAM DR STE 150
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-3346
Country	:	US
Telephone Number	:	281-351-5174
Fax Number	:	281-351-5172

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	12/24/2014

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Directions to “ DR. PENNER T SCHRAUDENBACH MD” Practice Location

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