# SPINE & SPORTSMEDICINE SPECIALISTS

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

## Provider details

- **NPI number:** 1457485666
- **Authorized official:** MICHAEL JEROME LORD M.D. (PRESIDENT)
- **Authorized official phone:** (904) 687-4224

## Contact information

- **Practice address:** 17327 BALLMONT PARK DR, ODESSA, FL 33556-6209
- **Practice address phone:** (904) 687-4224
- **Practice address fax:** (813) 852-2137
- **Mailing address:** 17327 BALLMONT PARK DR, ODESSA, FL 33556-6209
- **Mailing address phone:** (904) 687-4224
- **Mailing address fax:** (813) 852-2137

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/16/2007
- **Last updated:** 11/13/2012