Provider Demographics
NPI:1982784641
Name:NATTERER, ANN M (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:NATTERER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:GENDRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:6210 JOHN RYAN DR STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4111
Practice Address - Country:US
Practice Address - Phone:817-370-0840
Practice Address - Fax:817-370-8689
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5951208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111864805OtherCSHCN INDIVIDUAL TPI
TX137345810OtherCSHCN GROUP TPI
TX1727206OtherFIRSTHEALTH PIN
TX497935OtherPHCS PIN
1750369203OtherGRP NPI NUMBER
TX1840355OtherUHC PIN
TX140442852OtherMEDICAID GROUP TPI
TX5539729OtherAETN APIN
TX86982GOtherBCBSTX IND PIN
TXGENAF40546OtherCCHIP PIN
TX0818716OtherCIGNA PIN
TX111864804Medicaid
1750369203OtherGRP NPI NUMBER