Healthcare Provider Details

I. General information

NPI: 1609965078
Provider Name (Legal Business Name): KATHERINE MCQUEEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 WEST LOOP S SUITE 525
BELLAIRE TX
77401-3500
US

IV. Provider business mailing address

PO BOX 34
INGRAM TX
78025-0034
US

V. Phone/Fax

Practice location:
  • Phone: 713-661-7888
  • Fax: 713-661-7899
Mailing address:
  • Phone: 830-201-0880
  • Fax: 830-323-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL0414
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberL0414
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: