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General NPI Number Information
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NPI Number | 1689979031
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Entity Type | Organization
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Legal Business Name | NEUROSYM
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Dates
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Enumeration Date | 01/17/2011
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 8408 BROWN STONE LN
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City | FRISCO
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State | TX
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Zip | 75034-6277
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Country | US
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Telephone | 972-971-6161
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Fax |
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Provider Business Mailing Address
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Address Line | 8408 BROWN STONE LN
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City | FRISCO
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State | TX
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Zip | 75034-6277
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Country | US
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Telephone | 972-971-6161
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JASON LANE BOURQUE
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Credential | MBA
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Telephone | 972-971-6161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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