Healthcare Provider Details

I. General information

NPI: 1114060001
Provider Name (Legal Business Name): ANTOINE TAHKEAL R.T. (R)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TONY TAHKEAL R.T. (R)

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BUSTER RD
TOPPENISH WA
98948-9792
US

IV. Provider business mailing address

4210 HOLIDAY AVE
UNION GAP WA
98903-2110
US

V. Phone/Fax

Practice location:
  • Phone: 509-865-2102
  • Fax:
Mailing address:
  • Phone: 509-225-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number319831
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: