Healthcare Provider Details

I. General information

NPI: 1184474751
Provider Name (Legal Business Name): PATH PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 MATLOCK RD
ARLINGTON TX
76015-2529
US

IV. Provider business mailing address

2725 MATLOCK RD
ARLINGTON TX
76015-2529
US

V. Phone/Fax

Practice location:
  • Phone: 817-417-4027
  • Fax: 817-417-4043
Mailing address:
  • Phone: 817-417-4027
  • Fax: 817-417-4043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: HAMID KAMRAN
Title or Position: SOLE MBR
Credential: MD
Phone: 817-417-4027