Provider Demographics
NPI:1760700330
Name:NEUROPHYSIOLOGY
Entity type:Organization
Organization Name:NEUROPHYSIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOLAN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:JENEVEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-738-4961
Mailing Address - Street 1:8122 SAN FERNANDO WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4434
Mailing Address - Country:US
Mailing Address - Phone:214-738-4961
Mailing Address - Fax:
Practice Address - Street 1:6116 N CENTRAL EXPY
Practice Address - Street 2:SUITE 1000
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5162
Practice Address - Country:US
Practice Address - Phone:214-738-4961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH24922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty