Healthcare Provider Details

I. General information

NPI: 1548277924
Provider Name (Legal Business Name): JOHN RAMSEY TENNY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3503 W WHEATLAND RD SUITE 100
DALLAS TX
75237-3461
US

IV. Provider business mailing address

PO BOX 1029
RED OAK TX
75154-1029
US

V. Phone/Fax

Practice location:
  • Phone: 972-283-8700
  • Fax: 972-283-8704
Mailing address:
  • Phone: 972-283-8700
  • Fax: 972-283-8704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG0845
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberG0845
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberG0845
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: