Provider Demographics
NPI:1154376721
Name:CREDOR, HOWARD DWAYNE (CRNA)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:DWAYNE
Last Name:CREDOR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7946 N LOOP 1604 W
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-5174
Mailing Address - Country:US
Mailing Address - Phone:210-567-9100
Mailing Address - Fax:210-450-2165
Practice Address - Street 1:7946 N LOOP 1604 W
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-5174
Practice Address - Country:US
Practice Address - Phone:210-567-9100
Practice Address - Fax:210-450-2165
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN074876163W00000X
TX704230367500000X
TXAP113139367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB112087Medicare PIN