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General NPI Number Information
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NPI Number | 1508127408
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Entity Type | Organization
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Legal Business Name | LAKEWOOD ORTHOPEDICS AND SPORTS MEDICINE
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 1130 BEACHVIEW ST STE 100
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City | DALLAS
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State | TX
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Zip | 75218-3700
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Country | US
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Telephone | 469-341-5676
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Fax |
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Provider Business Mailing Address
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Address Line | 1130 BEACHVIEW ST STE 100
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City | DALLAS
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State | TX
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Zip | 75218-3700
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Country | US
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Telephone | 469-341-5676
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TERRY KEITH GEMAS
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Credential | MD
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Telephone | 469-341-5679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | L2276
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License Number State | TX
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