Provider Demographics
NPI:1487619334
Name:BRADFORD, KATRINA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:MARIE
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KATRINA
Other - Middle Name:MARIE
Other - Last Name:POSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3417 GASTON AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2031
Mailing Address - Country:US
Mailing Address - Phone:972-993-5000
Mailing Address - Fax:972-993-5001
Practice Address - Street 1:8144 WALNUT HILL LN STE 360
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4324
Practice Address - Country:US
Practice Address - Phone:972-993-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080172521OtherRR MEDICARE
TX1463309-01Medicaid
TX8B4280OtherBC/BS
TX1463309-01Medicaid
TXG68611Medicare UPIN