Provider Demographics
NPI:1003807801
Name:DIASE, KATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:DIASE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16651 SOUTHWEST FREEWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUGAR LAND
Mailing Address - State:TEXAS
Mailing Address - Zip Code:77479
Mailing Address - Country:UM
Mailing Address - Phone:713-774-5131
Mailing Address - Fax:713-774-4336
Practice Address - Street 1:16651 SOUTHWEST FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2345
Practice Address - Country:US
Practice Address - Phone:713-774-5131
Practice Address - Fax:713-774-4336
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0789207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P1261OtherBCBS
TX148453702Medicaid
TX2085936OtherFIRST HEALTH/CCN
TX1939678OtherCIGNA
TX7550242OtherAETNA
TX1939678OtherCIGNA
TX148453702Medicaid