Provider Demographics
NPI:1376757971
Name:ORTIZ, KATHRYN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ANN
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8625 KING GEORGE DR STE 111
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-2240
Mailing Address - Country:US
Mailing Address - Phone:214-631-7002
Mailing Address - Fax:214-631-6698
Practice Address - Street 1:8625 KING GEORGE DR STE 111
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-2240
Practice Address - Country:US
Practice Address - Phone:214-542-2363
Practice Address - Fax:214-631-6698
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH26582084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF00678Medicare UPIN