Organization
SOUTH TEXAS ORTHOPAEDIC & SPORTS MEDICINE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDERICK RYAN WADE KRAUSE M.D. (PRESIDENT)
(830) 393-0235
Entity
Organization
Contact information
Practice address
495 10TH ST, SUITE 104, FLORESVILLE, TX 78114-3162
(830) 393-0235
(830) 393-0413
Mailing address
495 10TH ST, SUITE 104, FLORESVILLE, TX 78114-3162
(830) 393-0235
(830) 393-0413
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
N5791
TX
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
N5791
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
BC/BS
TX
05
—
PENDING
—
TX
Enumeration date
08/10/2010
Last updated
08/10/2010
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