Organization
ORTHOPAEDICS SPORTS & WORKERS MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY ROYCE WISNER M.D. (PRESIDENT)
(209) 368-7777
Entity
Organization
Contact information
Practice address
621 S HAM LN STE A, LODI, CA 95242-3533
(209) 368-7777
(209) 368-7778
Mailing address
621 S HAM LN STE A, LODI, CA 95242-3533
(209) 368-7777
(209) 368-7778
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
A41236
CA
Other
Enumeration date
02/20/2007
Last updated
03/30/2010
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