Provider Demographics
NPI:1326013897
Name:DRKULEC, JOHN ANTUN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTUN
Last Name:DRKULEC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 120489
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-0489
Mailing Address - Country:US
Mailing Address - Phone:817-375-5200
Mailing Address - Fax:817-299-1708
Practice Address - Street 1:2800 E BROAD ST STE 124
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6410
Practice Address - Country:US
Practice Address - Phone:817-375-5200
Practice Address - Fax:817-299-1786
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL3627207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H55306Medicare UPIN
TX8G9336Medicare PIN