Organization
IMMANUEL BRAIN, SPINE AND NERVE SURGERY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN R. TEAL M.D. (PRESIDENT)
(817) 795-7337
Entity
Organization
Contact information
Practice address
624 MATLOCK CENTRE CIR, ARLINGTON, TX 76015-2536
(817) 795-7337
(817) 795-8393
Mailing address
624 MATLOCK CENTRE CIR, ARLINGTON, TX 76015-2536
(817) 795-7337
(817) 795-8393
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
J2368
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161312701
—
TX
Enumeration date
12/11/2006
Last updated
03/31/2009
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