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General NPI Number Information
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NPI Number | 1366079071
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Entity Type | Organization
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Legal Business Name | CENTRAL PLANO SPORTS SURGICAL ALLIANCE PLLC
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 5228 W PLANO PKWY
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City | PLANO
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State | TX
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Zip | 75093-5005
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Country | US
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Telephone | 972-374-5351
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Fax |
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Provider Business Mailing Address
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Address Line | 1141 N LOOP 1604 E # 105-612
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1339
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Country | US
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Telephone | 210-598-4262
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | RANDAL TROOP
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Credential |
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Telephone | 972-250-5442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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