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General NPI Number Information
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NPI Number | 1063817260
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Entity Type | Organization
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Legal Business Name | NORTHEAST ORTHOPAEDICS & SPORTS MEDICINE, LLP
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 12709 TOEPPERWEIN RD SUITE 101
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City | LIVE OAK
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State | TX
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Zip | 78233-3259
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Country | US
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Telephone | 210-477-5151
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Fax | 210-477-5152
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Provider Business Mailing Address
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Address Line | 12709 TOEPPERWEIN RD SUITE 101
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City | LIVE OAK
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State | TX
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Zip | 78233-3259
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Country | US
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Telephone | 210-477-5151
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Fax | 210-477-5152
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. DAVID L. FOX
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Credential | M.D.
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Telephone | 210-477-5151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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