Provider Demographics
NPI:1851345391
Name:SOUTHERLAND, NATALIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:J
Last Name:SOUTHERLAND
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:PO BOX 192444
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-8520
Mailing Address - Country:US
Mailing Address - Phone:469-420-0064
Mailing Address - Fax:469-574-0391
Practice Address - Street 1:206 YMCA DR STE 103
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5244
Practice Address - Country:US
Practice Address - Phone:694-200-0644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 88471207Q00000X
TXN5413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267819500Medicaid
TX8BU524OtherBCBSTX
TX218191901Medicaid
TXTXB112188Medicare PIN
FL81386WMedicare PIN
FL81386XMedicare PIN
FL267819500Medicaid