Provider Demographics
NPI:1144248501
Name:GLOVER, KATRINA Y (MD)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:Y
Last Name:GLOVER
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:PO BOX 731912
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-1912
Mailing Address - Country:US
Mailing Address - Phone:903-877-7635
Mailing Address - Fax:903-877-7754
Practice Address - Street 1:721 CLINIC DR
Practice Address - Street 2:STE A
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2043
Practice Address - Country:US
Practice Address - Phone:903-592-6152
Practice Address - Fax:903-592-5288
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0091207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F6320OtherBCBS
TXP00787093OtherRAILROAD MEDICARE
TX170559203Medicaid
8F6320OtherBCBS
TXI19194Medicare UPIN