Immanuel Brain, Spine and Nerve Surgery, PA

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

J2368 Issued in TX

Legal business name

IMMANUEL BRAIN, SPINE AND NERVE SURGERY, PA

Practice address

624 Matlock Centre Cir
Arlington, TX 76015-2536

Phone

(817) 795-7337

Fax

(817) 795-8393

NPI assigned

Dec 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin R. Teal, M.D.

Title

President

Phone

(817) 795-7337

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238457600000",
    "number": "1326108200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 MATLOCK CENTRE CIR",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760152536",
            "telephone_number": "817-795-7337",
            "fax_number": "817-795-8393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 MATLOCK CENTRE CIR",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760152536",
            "telephone_number": "817-795-7337",
            "fax_number": "817-795-8393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMANUEL BRAIN, SPINE AND NERVE SURGERY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2009-03-31",
        "status": "A",
        "authorized_official_last_name": "TEAL",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-795-7337",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "TX",
            "license": "J2368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "161312701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Neurological Surgery Physician in Arlington, TX
• Providers in Arlington, TX by specialty
• Neurological Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.