Basic Information
| Provider Information | |||||||||
| NPI: | 1356398168 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLADDEN | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | RALPH | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6300 LA CALMA DR STE 200 | ||||||||
| Address2: | LA COSTA CENTRE | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787523825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124528533 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6300 LA CALMA DRIVE, STE. 200 | ||||||||
| Address2: | LA COSTA CENTER | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124528533 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 03/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | A1217-03 | NM | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 178092605 | 05 | TX | MEDICAID | 178092602 | 05 | TX | MEDICAID | 178092604 | 05 | TX | MEDICAID | 178092606 | 05 | TX | MEDICAID | 178092607 | 05 | TX | MEDICAID |