Provider Demographics
NPI:1235358136
Name:DEEP SOUTH ORTHOPEDICS AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:DEEP SOUTH ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-724-7407
Mailing Address - Street 1:2400 HIGHWAY 365
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6249
Mailing Address - Country:US
Mailing Address - Phone:409-724-7407
Mailing Address - Fax:409-724-7479
Practice Address - Street 1:2400 HIGHWAY 365
Practice Address - Street 2:SUITE 207
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6249
Practice Address - Country:US
Practice Address - Phone:409-724-7407
Practice Address - Fax:409-724-7479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4323207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty