Basic Information
| Provider Information | |||||||||
| NPI: | 1598789117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOOLABH | ||||||||
| FirstName: | NEELAN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 846098 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752846098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033246450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 703 S FLEISHEL AVE | ||||||||
| Address2: | STE 5000 | ||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757012015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036067525 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 10/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | K1185 | TX | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 752616977107 | 01 | TX | TRICARE E LAKE STREET LOCATION | OTHER | 160211202 | 05 | TX | MEDICAID | K1185 | 01 | TX | MEDICAL LICENSE | OTHER | 160211201 | 05 | TX | MEDICAID | 752616977039 | 01 | TX | TRICARE NORTHPARK LOCATION | OTHER | 752616977110 | 01 | TX | TRICARE MAPS LOCATION | OTHER | 8AM683 | 01 | TX | BCBS | OTHER | 8J5071 | 01 | TX | BCBS PROVIDER | OTHER |