Unknown Individual – Clinical Neurophysiology Physician, NPI 1033620976
Clinical Neurophysiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
170, East Southlake Boulevard, Park Village, Southlake, Tarrant County, Texas, 76092, United States
SOUTHLAKE, TX 760926382
Phone: (817) 224-2292
Fax: (214) 853-5728
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 76092)
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