Healthcare Provider Details

I. General information

NPI: 1912923376
Provider Name (Legal Business Name): PEDIATRIC SPORTS AND SPINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W STATE HIGHWAY 114 SUITE 110
GRAPEVINE TX
76051-8649
US

IV. Provider business mailing address

2020 W STATE HIGHWAY 114 SUITE 110
GRAPEVINE TX
76051-8649
US

V. Phone/Fax

Practice location:
  • Phone: 817-310-0810
  • Fax: 817-812-3525
Mailing address:
  • Phone: 817-310-0810
  • Fax: 817-812-3525

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: DR. DAVID SCOTT BROWN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 817-310-0810