Provider Demographics
NPI:1255584421
Name:LARA DUDEK, MD PA
Entity type:Organization
Organization Name:LARA DUDEK, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARA
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUDEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-326-5900
Mailing Address - Street 1:PO BOX 40999
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0999
Mailing Address - Country:US
Mailing Address - Phone:512-326-5900
Mailing Address - Fax:512-326-5988
Practice Address - Street 1:1109A E 6TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3210
Practice Address - Country:US
Practice Address - Phone:512-326-5900
Practice Address - Fax:512-326-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9984207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1740461136OtherINDIVIDUAL NPI