Provider Demographics
NPI:1356398168
Name:GLADDEN, DONALD RALPH (DO)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:RALPH
Last Name:GLADDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 LA CALMA DR STE 200
Mailing Address - Street 2:LA COSTA CENTRE
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3825
Mailing Address - Country:US
Mailing Address - Phone:512-452-8533
Mailing Address - Fax:
Practice Address - Street 1:6300 LA CALMA DRIVE, STE. 200
Practice Address - Street 2:LA COSTA CENTER
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752
Practice Address - Country:US
Practice Address - Phone:512-452-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA1217-03207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178092605Medicaid
TX178092602Medicaid
TX178092604Medicaid
TX178092606Medicaid
TX178092607Medicaid
TX8J6960Medicare PIN
TX8J5179Medicare PIN
TX8L4244Medicare PIN
TX8F6604Medicare PIN
TX178092605Medicaid
TX178092607Medicaid