Healthcare Provider Details

I. General information

NPI: 1003805623
Provider Name (Legal Business Name): CATHERINE EMILY BIERSACK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 3RD ST W
RANDOLPH A F B TX
78150-4800
US

IV. Provider business mailing address

3103 SABLE CRK
SAN ANTONIO TX
78259-2636
US

V. Phone/Fax

Practice location:
  • Phone: 210-652-9626
  • Fax:
Mailing address:
  • Phone: 210-481-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101042319
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: