Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | K0282 | TX |
N | 207YP0228X | Pediatric Otolaryngology | K0282 | TX |
N | 207YS0123X | Facial Plastic Surgeon | K0282 | TX |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | K0282 | TX |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | K0282 | TX |
NPI | 1699752857 |
---|---|
Provider Name | Dr. John Walton Craddock JR. |
First Address | Houston, TX 77064-1240 |
Second Address | Houston, TX 77024-1735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 09/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H17202 | (02) | TX |