Provider Demographics
NPI:1952393415
Name:MAKOHON, KATHERINE R (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:R
Last Name:MAKOHON
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 1:4450 TUBBS RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6308
Mailing Address - Country:US
Mailing Address - Phone:972-722-3290
Mailing Address - Fax:972-722-3815
Practice Address - Street 1:4450 TUBBS RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6308
Practice Address - Country:US
Practice Address - Phone:972-722-3290
Practice Address - Fax:972-722-3815
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6483174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01152990OtherRR MEDICARE
TX160322703Medicaid
TX8G2492OtherBC/BS
TX01713713OtherAMERIGROUP
TX267222YN0QOtherMCPTAN
TXP01152990OtherRR MEDICARE
TX36-4712381OtherTIN#
TX10737457OtherCIGNA
TX752757262OtherTAX ID