Individual
DR. VITALY GOLUB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 702-3431
Mailing address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 702-3431
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
P6399
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03295778
—
NY
Enumeration date
07/14/2008
Last updated
06/11/2013
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