| NPI | 1194781773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL MCKENNA Do 940-627-3491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX J0118) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX K7089) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine | |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX M6477) | |
| 213E00000X Podiatrist (Licence: TX 1305) | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: TX J0118) | |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2024-12-24 |