Provider Demographics
NPI:1396273058
Name:MCGRUDER, CARLA (MD, CGC)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MCGRUDER
Suffix:
Gender:F
Credentials:MD, CGC
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:CHRISTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9715 BURNET RD
Mailing Address - Street 2:BLD. 7, ST 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5390
Mailing Address - Country:US
Mailing Address - Phone:512-505-5500
Mailing Address - Fax:512-334-2702
Practice Address - Street 1:900 E 30TH ST STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3378
Practice Address - Country:US
Practice Address - Phone:512-505-5500
Practice Address - Fax:512-334-2702
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000OtherN/A