Provider Demographics
NPI:1265455752
Name:KANE, ERIN P (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:P
Last Name:KANE
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 1:4001A WORTH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1608
Mailing Address - Country:US
Mailing Address - Phone:214-828-1745
Mailing Address - Fax:214-828-1734
Practice Address - Street 1:4001A WORTH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1608
Practice Address - Country:US
Practice Address - Phone:214-828-1745
Practice Address - Fax:214-828-1734
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2075012-01Medicaid
TX2075012-01Medicaid
GA08CBBRVMedicare PIN
TX8L20739Medicare PIN