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General NPI Number Information
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NPI Number | 1740558147
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Entity Type | Organization
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Legal Business Name | SPECIALTY ORTHOPEDICS P C
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 5210 POPLAR AVE SUITE 200
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City | MEMPHIS
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State | TN
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Zip | 38119-3515
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Country | US
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Telephone | 901-682-9161
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Fax | 901-767-9584
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Provider Business Mailing Address
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Address Line | 5210 POPLAR AVE SUITE 200
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City | MEMPHIS
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State | TN
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Zip | 38119-3515
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Country | US
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Telephone | 901-682-9161
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Fax | 901-767-9584
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RICHARD L ENNIS
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Credential | M.D.
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Telephone | 901-682-9161
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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 | 7341
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License Number State | TN
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