Provider Demographics
NPI:1912923376
Name:PEDIATRIC SPORTS AND SPINE ASSOCIATES
Entity Type:Organization
Organization Name:PEDIATRIC SPORTS AND SPINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-310-0810
Mailing Address - Street 1:2020 W STATE HIGHWAY 114
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8649
Mailing Address - Country:US
Mailing Address - Phone:817-310-0810
Mailing Address - Fax:817-812-3525
Practice Address - Street 1:2020 W STATE HIGHWAY 114
Practice Address - Street 2:SUITE 110
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8649
Practice Address - Country:US
Practice Address - Phone:817-310-0810
Practice Address - Fax:817-812-3525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty