1609136647 NPI number — KURT N. DOYLE CST,P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609136647 NPI number — KURT N. DOYLE CST,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KURT N. DOYLE CST,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609136647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3732 FENTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76133-2916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-223-3587
Provider Business Mailing Address Fax Number:
817-370-9020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3732 FENTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76133-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-223-3587
Provider Business Practice Location Address Fax Number:
817-370-9020
Provider Enumeration Date:
05/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DOYLE
Authorized Official First Name:
KURT
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CERT. SURGICAL TECH/FIRST ASSISTANT
Authorized Official Telephone Number:
817-223-3587

Provider Taxonomy Codes

  • Taxonomy code: 246ZS0410X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 127516 . This is a "NATIONAL BOARD OR SURGICAL TECHNOLOGY AND SURGICAL ASSISTING" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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