Provider Demographics
NPI:1083788830
Name:ERDMAN, KATHLEEN BARRY (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BARRY
Last Name:ERDMAN
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 1:5477 GLEN LAKES DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4375
Mailing Address - Country:US
Mailing Address - Phone:214-265-1342
Mailing Address - Fax:214-373-6444
Practice Address - Street 1:5477 GLEN LAKES DR
Practice Address - Street 2:SUITE 210
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4375
Practice Address - Country:US
Practice Address - Phone:214-265-1342
Practice Address - Fax:214-373-6444
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE70632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B22562Medicare UPIN
TX00F11AMedicare ID - Type Unspecified