Provider Demographics
NPI:1376771063
Name:KRAUSE, FREDERICK RYAN WADE (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:RYAN WADE
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 10TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-3162
Mailing Address - Country:US
Mailing Address - Phone:830-393-0235
Mailing Address - Fax:
Practice Address - Street 1:495 10TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3162
Practice Address - Country:US
Practice Address - Phone:830-393-0235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5791207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherBC/BS
TXPENDINGMedicaid
TXPENDINGMedicare PIN