Healthcare Provider Details

I. General information

NPI: 1114314523
Provider Name (Legal Business Name): D&P ORTHO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 PINECROFT DR STE 295
SHENANDOAH TX
77380-3222
US

IV. Provider business mailing address

PO BOX 9969
THE WOODLANDS TX
77387-6969
US

V. Phone/Fax

Practice location:
  • Phone: 281-746-3070
  • Fax: 281-970-5118
Mailing address:
  • Phone: 281-746-3070
  • Fax: 281-970-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberL6540
License Number StateTX

VIII. Authorized Official

Name: DAVID OMID NAVID
Title or Position: OWNER
Credential: DO
Phone: 281-746-3070