Individual
DR. KATHLEEN LOUISE SHIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
500 S HENDERSON ST STE 200, FORT WORTH, TX 76104-2154
(174) 131-5008
(817) 413-1499
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 437-9605
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
K3007
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166057302
—
TX
05
—
166057303
—
TX
01
—
8S3355
BLUE CROSS OF TEXAS
TX
Enumeration date
06/02/2006
Last updated
12/09/2021
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