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General NPI Number Information
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NPI Number | 1902264161
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Entity Type | Organization
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Legal Business Name | ORTHOSPORTS ASSOCIATES, LLC
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 02/03/2016
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Provider Practice Location Address
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Address Line | 7067 VERTERANS PARKWAY 200
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City | PELL CITY
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State | AL
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Zip | 35125-9368
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Country | US
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Telephone | 205-838-3090
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Fax |
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Provider Business Mailing Address
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Address Line | 833 SAINT VINCENTS DR BLDG 3, SUITE 403
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City | BIRMINGHAM
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State | AL
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Zip | 35205-1606
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Country | US
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Telephone | 205-939-0447
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID SHANE BUGGAY
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Credential | M.D.
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Telephone | 205-939-0447
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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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