# ORTHOPAEDICS SPORTS & WORKERS MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033254099
- **Authorized official:** DR. GARY ROYCE WISNER M.D. (PRESIDENT)
- **Authorized official phone:** (209) 368-7777

## Contact information

- **Practice address:** 621 S HAM LN STE A, LODI, CA 95242-3533
- **Practice address phone:** (209) 368-7777
- **Practice address fax:** (209) 368-7778
- **Mailing address:** 621 S HAM LN STE A, LODI, CA 95242-3533
- **Mailing address phone:** (209) 368-7777
- **Mailing address fax:** (209) 368-7778

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | A41236 | CA | Yes |

## Other

- **Enumeration date:** 02/20/2007
- **Last updated:** 03/30/2010