Provider Demographics
NPI:1396845079
Name:PIFER, KATHRYN ANN (DO)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:PIFER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 GATEWAY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-7906
Mailing Address - Country:US
Mailing Address - Phone:817-354-7999
Mailing Address - Fax:817-571-2140
Practice Address - Street 1:4214 GATEWAY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7906
Practice Address - Country:US
Practice Address - Phone:817-354-7999
Practice Address - Fax:817-571-2140
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D97629Medicare UPIN