Provider Demographics
NPI:1376001768
Name:ORTHOPEDIC INSTITUTE OF DALLAS, PLLC
Entity Type:Organization
Organization Name:ORTHOPEDIC INSTITUTE OF DALLAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUBITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-658-5106
Mailing Address - Street 1:701 TUSCAN DR STE 235
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3839
Mailing Address - Country:US
Mailing Address - Phone:817-658-5106
Mailing Address - Fax:
Practice Address - Street 1:701 TUSCAN DR STE 235
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3839
Practice Address - Country:US
Practice Address - Phone:817-658-5106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty