Provider Demographics
NPI:1255535829
Name:RADCLIFFE, KAREN QUINTAVELL (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:QUINTAVELL
Last Name:RADCLIFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:QUINTAVELL
Other - Last Name:LOOP/DESCOUTEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:201 ENTERPRISE AVENUE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573
Mailing Address - Country:US
Mailing Address - Phone:832-848-0444
Mailing Address - Fax:
Practice Address - Street 1:201 ENTERPRISE AVENUE
Practice Address - Street 2:SUITE 800
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573
Practice Address - Country:US
Practice Address - Phone:832-848-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0026309207ZP0101X
TXP1391207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3879138231OtherMYUTMB 3879138231-COMMERCIAL NUMBER