Individual
KATHARINE PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7777 FOREST LN, DALLAS, TX 75230-2505
(972) 566-2667
Mailing address
7933 BRIARIDGE RD, DALLAS, TX 75248-5315
(972) 661-1529
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
L9427
TX
208000000X
Pediatrics Physician
L9427
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0033PT
BCBS
TX
05
—
173055803
—
TX
05
—
173055804
—
TX
01
—
173055811
CSHCN
TX
01
—
8S2685
BCBS
TX
Enumeration date
01/12/2006
Last updated
04/12/2012
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