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General NPI Number Information
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NPI Number | 1518144468
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Entity Type | Organization
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Legal Business Name | ORTHOPAEDIC SPORTS MEDICINE
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 425 WESTPARK WAY SUITE A
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City | EULESS
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State | TX
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Zip | 76040-3751
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Country | US
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Telephone | 817-283-0806
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Fax | 817-545-7569
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Provider Business Mailing Address
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Address Line | 425 WESTPARK WAY SUITE A
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City | EULESS
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State | TX
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Zip | 76040-3751
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Country | US
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Telephone | 817-283-0806
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Fax | 817-545-7569
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD KOJI YAMAMOTO
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Credential | MC
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Telephone | 817-283-0806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | E5291
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License Number State | TX
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