Provider Demographics
NPI:1982976205
Name:HARRELL, CATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 SOUTHWEST BLVD
Mailing Address - Street 2:STE 315
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3985
Mailing Address - Country:US
Mailing Address - Phone:817-885-8222
Mailing Address - Fax:
Practice Address - Street 1:800 8TH AVE
Practice Address - Street 2:STE 326
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2602
Practice Address - Country:US
Practice Address - Phone:817-885-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP20039384207N00000X, 207R00000X
TXP2057207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX353775YLUXMedicare PIN
TX353775YME1Medicare PIN
TX353775YLUVMedicare PIN