Provider Demographics
NPI:1508831876
Name:GLASS, KATHRYN B (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:B
Last Name:GLASS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:909 FROSTWOOD DR
Mailing Address - Street 2:SUITE 1.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-4523
Mailing Address - Fax:713-338-5500
Practice Address - Street 1:6400 FANNIN ST STE 2015
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1521
Practice Address - Country:US
Practice Address - Phone:713-704-0669
Practice Address - Fax:713-704-0670
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2012-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101225444208000000X
TXP1458208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA432058755OtherPHCS
VA4768718/9149430OtherCIGNA
VA3649627OtherAETNA HMO
VA41232OtherOPTIMA HEALTH
VA7358237OtherAETNA PPO
VA006703712Medicaid
VA294140OtherANTHEM BC
VA633510OtherSOUTHERN HEALTH
VA432058755OtherGREAT WEST
VA432058755OtherTRICARE
VA8165265OtherUNITED HEALTHCARE
VA432058755OtherGREAT WEST