Basic Information
Provider Information
NPI: 1386803849
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLANGIN
FirstName: KATHRYN
MiddleName: M.
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 660599
Address2:  
City: DALLAS
State: TX
PostalCode: 752660599
CountryCode: US
TelephoneNumber: 2145904105
FaxNumber:  
Practice Location
Address1: 111 COMMERCE ST
Address2: DALLAS COUNTY JAIL HEALTH
City: DALLAS
State: TX
PostalCode: 752077401
CountryCode: US
TelephoneNumber: 2147125058
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/09/2008
LastUpdateDate: 06/09/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208D00000XE2557TXY Allopathic & Osteopathic PhysiciansGeneral Practice 

No ID Information.


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