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General NPI Number Information
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NPI Number | 1821321415
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Entity Type | Individual
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Provider Name | ANATOLIY NEKOZ D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 1500 S MAIN ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4917
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Country | US
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Telephone | 817-927-1661
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Fax |
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Provider Business Mailing Address
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Address Line | 3249 SHORESIDE PKWY
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City | HURST
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State | TX
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Zip | 76053-7529
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Country | US
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Telephone | 201-916-4449
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | BP20035654
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License Number State | TX
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