Individual
MARTIN PILAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0312
(817) 317-7033
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-0312
(817) 317-7033
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
200345
LA
2085R0202X
Diagnostic Radiology Physician
Primary
N1419
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07182
—
LA
01
—
8BZ818
BCBS
TX
Enumeration date
05/23/2007
Last updated
08/15/2012
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