Provider Demographics
NPI:1285645507
Name:DOYLE, KURT N (CST/FA)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:N
Last Name:DOYLE
Suffix:
Gender:M
Credentials:CST/FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3732 FENTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-2916
Mailing Address - Country:US
Mailing Address - Phone:817-370-9020
Mailing Address - Fax:817-886-8480
Practice Address - Street 1:3732 FENTON AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-2916
Practice Address - Country:US
Practice Address - Phone:817-370-9020
Practice Address - Fax:817-886-8480
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87848246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2936539OtherEIN