Provider Demographics
NPI:1689636748
Name:MEZERA, KIMBERLY KAY (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:MEZERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 N CENTRAL EXPY
Mailing Address - Street 2:STE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0804
Mailing Address - Country:US
Mailing Address - Phone:214-645-3300
Mailing Address - Fax:
Practice Address - Street 1:9301 N CENTRAL EXPY
Practice Address - Street 2:STE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0804
Practice Address - Country:US
Practice Address - Phone:214-347-7800
Practice Address - Fax:214-347-7800
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2207207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037177501Medicaid
F58836Medicare UPIN
TXME080461KMedicare ID - Type Unspecified