Provider Demographics
NPI:1962663682
Name:PERFORMANCE ORTHOPAEDICS & SPORTS MEDICINE, P.A.
Entity Type:Organization
Organization Name:PERFORMANCE ORTHOPAEDICS & SPORTS MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-705-6611
Mailing Address - Street 1:14660 STATE HWY 121
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-4605
Mailing Address - Country:US
Mailing Address - Phone:214-705-6611
Mailing Address - Fax:
Practice Address - Street 1:14660 STATE HWY 121
Practice Address - Street 2:SUITE 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4605
Practice Address - Country:US
Practice Address - Phone:214-705-6611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198404901Medicaid
00Z590Medicare PIN
TX198404901Medicaid