Provider Demographics
NPI:1376771063
Name:KRAUSE, FREDERICK RYAN WADE (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:RYAN WADE
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 S HIGHWAY 181
Mailing Address - Street 2:
Mailing Address - City:KENEDY
Mailing Address - State:TX
Mailing Address - Zip Code:78119-5247
Mailing Address - Country:US
Mailing Address - Phone:830-583-9339
Mailing Address - Fax:
Practice Address - Street 1:3349 S HIGHWAY 181 STE 5
Practice Address - Street 2:
Practice Address - City:KENEDY
Practice Address - State:TX
Practice Address - Zip Code:78119-5247
Practice Address - Country:US
Practice Address - Phone:830-583-9339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5791207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherBC/BS
TXPENDINGMedicaid
TXPENDINGMedicare PIN