MEDICARE: SPORTS & ORTHOPAEDIC GROUP OF DALLAS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	207X00000X	Orthopaedic Surgery Physician	TX
2	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	TX
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	TX

General Provider Information

NPI Number	:	1871514679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPORTS & ORTHOPAEDIC GROUP OF DALLAS

Provider Business Mailing Address
First Line	:	6901 SNIDER PLZ STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-5651
Country	:	US
Telephone Number	:	214-369-7733
Fax Number	:	214-369-7739

Provider Business Practice Location Address
First Line	:	6901 SNIDER PLZ
Second Line	:	STE 200
City	:	DALLAS
State	:	TX
Zip	:	75205-5651
Country	:	US
Telephone Number	:	214-369-7733
Fax Number	:	214-369-7739

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MS. SHELLEY D. COOLEY
Credential	:
Telephone Number	:	214-369-7733

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/16/2007

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Directions to “SPORTS & ORTHOPAEDIC GROUP OF DALLAS ” Practice Location

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