MEDICARE: DR. DONALD O OZUMBA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	M1994	TX

General Provider Information

NPI Number	:	1083615223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD O OZUMBA MD

Provider Business Mailing Address
First Line	:	3523 MCKINNEY AVE # 354
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-1401
Country	:	US
Telephone Number	:	214-707-4705
Fax Number	:	214-824-7755

Provider Business Practice Location Address
First Line	:	1015 N CARROLL AVE
Second Line	:	SUITE #2000
City	:	DALLAS
State	:	TX
Zip	:	75204-6613
Country	:	US
Telephone Number	:	214-824-7744
Fax Number	:	214-824-7755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/03/2012

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