=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265611065
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN T ROOKER RDMS, RVT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2007
-----------------------------------------------------
Last Update Date | 10/29/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2921 BROWN TRL SUITE 150
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76021-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-849-8700
-----------------------------------------------------
Fax | 817-849-8701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2921 BROWN TRL SUITE 150
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76021-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-849-8700
-----------------------------------------------------
Fax | 817-849-8701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2471S1302X
-----------------------------------------------------
Taxonomy Name | Sonography Radiologic Technologist
-----------------------------------------------------
License Number | 12470
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2471V0105X
-----------------------------------------------------
Taxonomy Name | Vascular Sonography Radiologic Technologist
-----------------------------------------------------
License Number | 12470
-----------------------------------------------------
License Number State |
-----------------------------------------------------