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Individual

DR. KATHLEEN SHADLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
6565 FANNIN ST, SUITE AX121B, HOUSTON, TX 77030-2703
(713) 441-4800
(713) 793-1300
Mailing address
6565 FANNIN ST, SUITE AX121B, HOUSTON, TX 77030-2703
(713) 441-4800
(713) 793-1300

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
J1038
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
129641001
TX
05
129641006
TX
05
129641007
TX
01
129641008
MEDICAID CSHCN
TX
05
129641009
TX
05
129641010
TX
01
85471R
BLUE CROSS
TX
01
8BN489
BLUE CROSS BLUE SHIELD
TX
01
8FU326
BLUE CROSS BLUE SHIELD
TX
01
P00747796
RR MEDICARE
TX
Enumeration date
08/19/2005
Last updated
07/08/2016
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