Provider Demographics
NPI:1841580727
Name:NORTHEAST ORTHOPAEDIC & SPORTS MEDICINE, LLP
Entity Type:Organization
Organization Name:NORTHEAST ORTHOPAEDIC & SPORTS MEDICINE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-477-5151
Mailing Address - Street 1:12709 TOEPPERWEIN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3258
Mailing Address - Country:US
Mailing Address - Phone:210-477-5151
Mailing Address - Fax:210-477-5152
Practice Address - Street 1:12709 TOEPPERWEIN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3258
Practice Address - Country:US
Practice Address - Phone:210-477-5151
Practice Address - Fax:210-477-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5882174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty