Healthcare Provider Details

I. General information

NPI: 1720428345
Provider Name (Legal Business Name): FORT BEND ORTHOPAEDIC SURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12812 HACIENDA RDG
AUSTIN TX
78738-7652
US

IV. Provider business mailing address

62 GREENSWARD LN
SUGAR LAND TX
77479-2503
US

V. Phone/Fax

Practice location:
  • Phone: 512-563-5015
  • Fax: 512-597-2159
Mailing address:
  • Phone: 281-265-1099
  • Fax: 512-597-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberF1427
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RUSSELL DAVID CALVO JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 512-563-5015