Provider Demographics
NPI:1093764664
Name:THRASH, CANDACE (MD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:
Last Name:THRASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 MEDICAL PKWY STE 340
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1023
Mailing Address - Country:US
Mailing Address - Phone:512-454-3781
Mailing Address - Fax:512-454-4058
Practice Address - Street 1:3705 MEDICAL PKWY STE 340
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1023
Practice Address - Country:US
Practice Address - Phone:512-454-3781
Practice Address - Fax:512-454-4058
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-108382207N00000X
TXL8216207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH97895Medicare UPIN
IL036-108382Medicare ID - Type Unspecified