Provider Demographics
NPI:1700171196
Name:DURHAM, KATHRYN (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:DURHAM
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 1:2801 S HULEN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1517
Mailing Address - Country:US
Mailing Address - Phone:817-921-2838
Mailing Address - Fax:817-921-2833
Practice Address - Street 1:2801 S HULEN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1517
Practice Address - Country:US
Practice Address - Phone:817-921-2838
Practice Address - Fax:817-921-2833
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8050207N00000X
TXBP10041504207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX519313ZU9PMedicare PIN