Provider Demographics
NPI:1508828146
Name:WHITE ROCK ORTHOPEDIC ASSOCIATION
Entity Type:Organization
Organization Name:WHITE ROCK ORTHOPEDIC ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-660-0505
Mailing Address - Street 1:10611 GARLAND RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2666
Mailing Address - Country:US
Mailing Address - Phone:214-660-0505
Mailing Address - Fax:214-660-4484
Practice Address - Street 1:10611 GARLAND RD
Practice Address - Street 2:SUITE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2666
Practice Address - Country:US
Practice Address - Phone:214-660-0505
Practice Address - Fax:214-660-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5492190001OtherDME/PALMETTO
TX0046MSOtherBCBS
TXDD5388OtherRAILROAD MEDICARE
TX00298ZMedicare ID - Type Unspecified
TX0046MSOtherBCBS