Provider Demographics
NPI:1699752857
Name:CRADDOCK, JOHN WALTON JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WALTON
Last Name:CRADDOCK
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:10740 N GESSNER RD STE 310
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-890-8908
Practice Address - Street 1:8731 KATY FWY STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1735
Practice Address - Country:US
Practice Address - Phone:832-678-8333
Practice Address - Fax:713-467-0965
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2021-08-09
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Provider Licenses
StateLicense IDTaxonomies
TXK0282207YP0228X, 207YS0012X, 207YS0123X, 207YX0007X, 207YX0602X, 207YX0905X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8550K0Medicare ID - Type UnspecifiedMEDICARE NUMBER
TX00P014Medicare PIN
TXH17202Medicare UPIN