MEDICARE: LAKEWOOD ORTHOPEDICS AND SPORTS MEDICINE

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	174400000X	Specialist	L2276	TX

General Provider Information

NPI Number	:	1508127408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWOOD ORTHOPEDICS AND SPORTS MEDICINE

Provider Business Mailing Address
First Line	:	1130 BEACHVIEW ST
Second Line	:	STE 100
City	:	DALLAS
State	:	TX
Zip	:	75218-3700
Country	:	US
Telephone Number	:	469-341-5676
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 BEACHVIEW ST
Second Line	:	STE 100
City	:	DALLAS
State	:	TX
Zip	:	75218-3700
Country	:	US
Telephone Number	:	469-341-5676
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TERRY KEITH GEMAS
Credential	:	MD
Telephone Number	:	469-341-5679

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	06/06/2012

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Directions to “LAKEWOOD ORTHOPEDICS AND SPORTS MEDICINE ” Practice Location

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