Healthcare Provider Details

I. General information

NPI: 1609136647
Provider Name (Legal Business Name): KURT N. DOYLE CST,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3732 FENTON AVE
FORT WORTH TX
76133-2916
US

IV. Provider business mailing address

3732 FENTON AVE
FORT WORTH TX
76133-2916
US

V. Phone/Fax

Practice location:
  • Phone: 817-223-3587
  • Fax: 817-370-9020
Mailing address:
  • Phone: 817-223-3587
  • Fax: 817-370-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. KURT N DOYLE
Title or Position: CERT. SURGICAL TECH/FIRST ASSISTANT
Credential: CST
Phone: 817-223-3587