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NPI Code Detail

MEDICARE: OLSV5 PLLC

MEDICARE: OLSV5 PLLC
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
1207X00000XOrthopaedic Surgery Physician

General Provider Information

NPI Number : 1306407341
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLSV5 PLLC
Provider Business Mailing Address
First Line : 7115 GREENVILLE AVE STE 310
Second Line :
City : DALLAS
State : TX
Zip : 75231-5103
Country : US
Telephone Number : 713-799-2300
Fax Number :
Provider Business Practice Location Address
First Line : 7115 GREENVILLE AVE STE 310
Second Line :
City : DALLAS
State : TX
Zip : 75231-5103
Country : US
Telephone Number : 713-799-2300
Fax Number :
Authorized Official
Title or Position : PRINCIPLE PHYSICIAN
Name : JACK BRYAN WILLIAMSON
Credential : MD
Telephone Number : 713-799-2300
Provider Enumeration Date : 06/20/2019
Last Update Date : 06/20/2019

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Directions to “OLSV5 PLLC ” Practice Location

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