Healthcare Provider Details

I. General information

NPI: 1326512161
Provider Name (Legal Business Name): NORTH TEXAS ORTHOPEDICS SURGICAL PARTNERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 IRA E WOODS AVE
GRAPEVINE TX
76051-3930
US

IV. Provider business mailing address

PO BOX 9879
SPRING TX
77387-6879
US

V. Phone/Fax

Practice location:
  • Phone: 817-527-0361
  • Fax: 817-488-4493
Mailing address:
  • Phone: 800-785-8765
  • Fax: 281-453-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: KERRY DONEGAN
Title or Position: MANAGER
Credential: MD
Phone: 817-527-0361