Healthcare Provider Details

I. General information

NPI: 1871860882
Provider Name (Legal Business Name): ORTHOPEDIC ASSOCIATES OF DALLAS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4708 ALLIANCE BLVD SUITE 310
PLANO TX
75093-5340
US

IV. Provider business mailing address

3900 JUNIUS ST SUITE 500
DALLAS TX
75246-1615
US

V. Phone/Fax

Practice location:
  • Phone: 214-823-7090
  • Fax: 214-823-1644
Mailing address:
  • Phone: 214-823-7090
  • Fax: 214-823-1644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TRACY L JACKSON
Title or Position: CEO
Credential:
Phone: 214-818-1200