Provider Demographics
NPI:1841231586
Name:DIAS, KERYN MARIE (MD)
Entity type:Individual
Prefix:
First Name:KERYN
Middle Name:MARIE
Last Name:DIAS
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 1:515 W MAYFIELD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2084
Mailing Address - Country:US
Mailing Address - Phone:817-277-7133
Mailing Address - Fax:817-274-6367
Practice Address - Street 1:5200 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7709
Practice Address - Country:US
Practice Address - Phone:214-648-4805
Practice Address - Fax:214-645-0075
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8994207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101562003Medicaid
TX80X138Medicare ID - Type Unspecified
TX101562003Medicaid
TX101562002Medicare ID - Type Unspecified