Provider Demographics
NPI:1467556100
Name:SHRADER, KAREN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELIZABETH
Last Name:SHRADER
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 1:429 N GUN BARREL LANE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:GUN BARREL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75156
Mailing Address - Country:US
Mailing Address - Phone:903-887-2704
Mailing Address - Fax:903-887-4910
Practice Address - Street 1:429 N GUN BARREL LANE
Practice Address - Street 2:SUITE 111
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156
Practice Address - Country:US
Practice Address - Phone:903-887-2704
Practice Address - Fax:903-887-4910
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8B2550OtherBCBS
4335905OtherAETNA
B26431Medicare UPIN
8B2550OtherBCBS