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General NPI Number Information
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NPI Number | 1558088682
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Entity Type | Organization
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Legal Business Name | REPUBLIC BRAIN SPINE AND ORTHOPEDIC
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Dates
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Enumeration Date | 10/19/2022
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 2291 PACHECO ST
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City | CONCORD
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State | CA
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Zip | 94520-2015
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Country | US
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Telephone | 925-397-9480
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 STATE HIGHWAY 121 STE 405
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City | LEWISVILLE
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State | TX
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Zip | 75056-4952
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Country | US
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Telephone | 469-817-9611
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Fax |
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Authorized Official
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Title or Position | CRO
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Name | SETH JACKNOWITZ
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Credential |
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Telephone | 561-699-7479
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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 |
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License Number State |
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