Provider Demographics
NPI:1740461136
Name:DUDEK, LARA T (MD)
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:T
Last Name:DUDEK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:13830 SAWYER RANCH ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-5246
Mailing Address - Country:US
Mailing Address - Phone:512-213-2220
Mailing Address - Fax:512-213-2237
Practice Address - Street 1:13830 SAWYER RANCH ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-5246
Practice Address - Country:US
Practice Address - Phone:512-213-2220
Practice Address - Fax:512-213-2237
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2016-03-30
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Provider Licenses
StateLicense IDTaxonomies
TXM9984207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2046815-04Medicaid
TX2046815-04Medicaid
TX613490Medicare PIN
TX473722ZTARMedicare PIN