MEDICARE: NEUROPHYSIOLOGY PROFESSIONAL ASSOCIATES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	H2492	TX

General Provider Information

NPI Number	:	1114318797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROPHYSIOLOGY PROFESSIONAL ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	6125 LUTHER LN
Second Line	:	SUITE 442
City	:	DALLAS
State	:	TX
Zip	:	75225-6202
Country	:	US
Telephone Number	:	214-536-1647
Fax Number	:	214-580-7600

Provider Business Practice Location Address
First Line	:	6116 N CENTRAL EXPY
Second Line	:	SUITE 1000
City	:	DALLAS
State	:	TX
Zip	:	75206-5162
Country	:	US
Telephone Number	:	214-536-1647
Fax Number	:	214-580-7600

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NOLAN BRUCE JENEVEIN
Credential	:	MD
Telephone Number	:	214-738-4961

Provider Enumeration Date	:	02/18/2015
Last Update Date	:	02/18/2015

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