Provider Demographics
NPI:1720428345
Name:FORT BEND ORTHOPAEDIC SURGERY, PA
Entity Type:Organization
Organization Name:FORT BEND ORTHOPAEDIC SURGERY, PA
Other - Org Name:TEXAS CENTER FOR SPORTS MEDICINE AND ORTHOPAEDIC SURGERY, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CALVO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:512-563-5015
Mailing Address - Street 1:62 GREENSWARD LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2503
Mailing Address - Country:US
Mailing Address - Phone:281-265-1099
Mailing Address - Fax:512-597-2159
Practice Address - Street 1:12812 HACIENDA RDG
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-7652
Practice Address - Country:US
Practice Address - Phone:512-563-5015
Practice Address - Fax:512-597-2159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
202D00000X, 207X00000X
TXF1427207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9678N0Medicare PIN
TXC14097Medicare UPIN