Provider Demographics
NPI:1780942474
Name:FEETHAM, HATTIE JILL (MD)
Entity type:Individual
Prefix:
First Name:HATTIE
Middle Name:JILL
Last Name:FEETHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HATTIE
Other - Middle Name:JILL
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8201 PRESTON RD STE 350
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6225
Mailing Address - Country:US
Mailing Address - Phone:214-631-7546
Mailing Address - Fax:214-631-8546
Practice Address - Street 1:8201 PRESTON RD STE 350
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6225
Practice Address - Country:US
Practice Address - Phone:214-631-7546
Practice Address - Fax:214-631-8546
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX565428207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX565428OtherTMB ID#
TXQ6505OtherTMB