Provider Demographics
NPI:1639122625
Name:KATZEN, KEVIN DEAN (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DEAN
Last Name:KATZEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S MAIN ST STE 3.500
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2410
Mailing Address - Country:US
Mailing Address - Phone:817-882-2590
Mailing Address - Fax:817-882-2591
Practice Address - Street 1:600 S MAIN ST STE 3.500
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2410
Practice Address - Country:US
Practice Address - Phone:817-882-2590
Practice Address - Fax:817-882-2591
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87814FOtherBCBS
TX115830502Medicaid
TX115830502Medicaid
TX87814FMedicare PIN
TX87814FOtherBCBS