Provider Demographics
NPI:1407050008
Name:HARRIS, KATHLEEN WEINDORFF (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:WEINDORFF
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:MICHELLE
Other - Last Name:WEINDORFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 610363
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75261-0363
Mailing Address - Country:US
Mailing Address - Phone:903-291-6187
Mailing Address - Fax:903-237-1810
Practice Address - Street 1:709 HOLLYBROOK DR
Practice Address - Street 2:SUITE 4500
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605
Practice Address - Country:US
Practice Address - Phone:903-757-6042
Practice Address - Fax:903-232-8260
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194166803Medicaid
TXTXB147307Medicare PIN