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General NPI Number Information
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NPI Number | 1720965619
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Entity Type | Organization
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Legal Business Name | AXONBLU DIAGNOSTICS LLC
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 3548 MCBROOM ST
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City | DALLAS
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State | TX
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Zip | 75212-2346
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Country | US
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Telephone | 817-422-1614
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Fax |
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Provider Business Mailing Address
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Address Line | 3548 MCBROOM ST
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City | DALLAS
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State | TX
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Zip | 75212-2346
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CALEB J HINTON
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Credential |
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Telephone | 817-422-1614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084E0001X
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Taxonomy Name | Epilepsy Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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