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General NPI Number Information
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NPI Number | 1710323019
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Entity Type | Organization
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Legal Business Name | KATHLEEN M BYNUM, DO, PA
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 5323 MILLER AVE
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City | DALLAS
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State | TX
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Zip | 75206-6422
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Country | US
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Telephone | 214-823-6762
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 720953
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City | DALLAS
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State | TX
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Zip | 75372-0953
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Country | US
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Telephone | 214-823-6762
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHLEEN BYNUM
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Credential | DO
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Telephone | 214-823-6762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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