MEDICARE: ORTHOPEDIC 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	207X00000X	Orthopaedic Surgery Physician		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0095CG	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1629018395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC AND SPORTS MEDICINE

Provider Business Mailing Address
First Line	:	321 N HIGHLAND AVE STE 120
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75092
Country	:	US
Telephone Number	:	903-870-7936
Fax Number	:	903-957-0367

Provider Business Practice Location Address
First Line	:	321 N HIGHLAND AVE STE 120
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75092-7371
Country	:	US
Telephone Number	:	903-870-7936
Fax Number	:	903-957-0367

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. STEPHEN DEGNAN SANDOVAL
Credential	:	M.D.
Telephone Number	:	903-870-7936

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	05/25/2022

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Directions to “ORTHOPEDIC AND SPORTS MEDICINE ” Practice Location

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