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Organization
417 SPORTS MEDICINE AND ORTHOPEDICS LLC
Active
Organization
417 SPORTS MEDICINE AND ORTHOPEDICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC GIFFORD MD (PHYSICIAN)
(817) 825-5096
Entity
Organization
Contact information
Practice address
3328 S NATIONAL AVE, SPRINGFIELD, MO 65807-7305
(417) 771-3147
Mailing address
2100 E NORSHIRE ST, SPRINGFIELD, MO 65804-7829
(817) 825-5096
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
NULL
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
08/17/2020
Last updated
05/16/2024
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