Provider Demographics
NPI:1255710679
Name:CORNELIUS, KATHRYN CALHOUN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:CALHOUN
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3600 GASTON AVE STE 755
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1907
Mailing Address - Country:US
Mailing Address - Phone:214-823-4200
Mailing Address - Fax:
Practice Address - Street 1:3600 GASTON AVE STE 755
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1907
Practice Address - Country:US
Practice Address - Phone:214-823-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR0845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty