Provider Demographics
NPI:1932100633
Name:BIRDY, KAREN SUE (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:BIRDY
Suffix:
Gender:F
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:PO BOX 126409
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-0409
Mailing Address - Country:US
Mailing Address - Phone:817-737-3331
Mailing Address - Fax:817-737-2333
Practice Address - Street 1:9239 VISTA WAY
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-2451
Practice Address - Country:US
Practice Address - Phone:817-737-3331
Practice Address - Fax:817-737-2333
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2008-11-20
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
TXK7663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0026REOtherBCBS
TX0026REOtherBCBS