Provider Demographics
NPI:1508067760
Name:BIRDWELL, KATRINA PAULINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:PAULINE
Last Name:BIRDWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATRINA
Other - Middle Name:PAULINE
Other - Last Name:EMMETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:221 W COLORADO BLVD
Practice Address - Street 2:PAV II, SUITE 532
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2363
Practice Address - Country:US
Practice Address - Phone:214-943-8605
Practice Address - Fax:214-946-8339
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0580208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX306166505Medicaid
TX306166504Medicaid
TX306166506Medicaid
TX306166505Medicaid
TX306166506Medicaid
TX368989YTU3Medicare PIN
TX306166504Medicaid
TX368989YM09Medicare PIN
TXTXB162778Medicare PIN