| NPI | 1750706347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BECKY TREVATHAN Credentialing Specialist 254-340-4046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0801X Orthopaedic Surgery Orthopaedic Trauma |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207X00000X Orthopaedic Surgery | |
| 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine | |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2018-04-17 |