Healthcare Provider Details

I. General information

NPI: 1619556511
Provider Name (Legal Business Name): KATHERINE VIRGINIA DEAGAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 W WHEATLAND RD
DALLAS TX
75237-3460
US

IV. Provider business mailing address

3500 W WHEATLAND RD
DALLAS TX
75237-3460
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-5400
  • Fax: 214-947-5425
Mailing address:
  • Phone: 214-947-5400
  • Fax: 214-947-5425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10074704
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU7666
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: