Provider Demographics
NPI:1477738409
Name:SCHRAUDENBACH, PENNER T (MD)
Entity Type:Individual
Prefix:DR
First Name:PENNER
Middle Name:T
Last Name:SCHRAUDENBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:506 GRAHAM DR STE 150
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3346
Practice Address - Country:US
Practice Address - Phone:281-351-5174
Practice Address - Fax:281-351-5172
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1132208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01366412OtherRAILROAD MEDICARE
TXTXB120824OtherMEDICARE HARRIS
TX338511401Medicaid
TX1700816428OtherNPI
TX338511402Medicaid
TXTXB120811OtherMEDICARE MONTGOMERY
TXP01366412OtherRAILROAD MEDICARE
TXTXB120811OtherMEDICARE MONTGOMERY