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General NPI Number Information
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NPI Number | 1619078920
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Entity Type | Organization
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Legal Business Name | CENTRAL TEXAS ORTHOPEDIC SURGERY,P.A.
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 2510 CROCKETT DR SUITE A
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City | BROWNWOOD
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State | TX
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Zip | 76801-5928
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Country | US
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Telephone | 325-643-5513
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 CROCKETT DR SUITE A
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City | BROWNWOOD
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State | TX
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Zip | 76801-5928
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Country | US
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Telephone | 325-643-5513
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. CRESCENT L CLARK
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Credential |
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Telephone | 325-643-5513
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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 | J6662
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License Number State | TX
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