Healthcare Provider Details

I. General information

NPI: 1265104939
Provider Name (Legal Business Name): PEDI-ORTHO HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 WELBORN ST
DALLAS TX
75219-3924
US

IV. Provider business mailing address

2222 WELBORN ST
DALLAS TX
75219-3924
US

V. Phone/Fax

Practice location:
  • Phone: 214-559-5000
  • Fax: 214-443-7309
Mailing address:
  • Phone: 214-559-5000
  • Fax: 214-443-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT WALKER
Title or Position: CEO
Credential:
Phone: 214-559-5000