Provider Demographics
NPI:1861431256
Name:ARREDONDO, ERADIO (MD)
Entity type:Individual
Prefix:
First Name:ERADIO
Middle Name:
Last Name:ARREDONDO
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 1:8100 DONORE PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2620
Mailing Address - Country:US
Mailing Address - Phone:210-349-3050
Mailing Address - Fax:
Practice Address - Street 1:730 N MAIN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1152
Practice Address - Country:US
Practice Address - Phone:210-226-9311
Practice Address - Fax:210-225-6270
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMD8137174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
40016344OtherDPS NUMBER
26664OtherECFMG NUMBER
AA4174227OtherDEA NUMBER
40016344OtherDPS NUMBER
26664OtherECFMG NUMBER