Organization
LAKEWOOD ORTHOPAEDICS & SPORTS MEDICINE, PA
Active
Parent organization
LAKEWOOD ORTHOPAEDICS & SPORTS MEDICINE
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKEWOOD ORTHOPAEDICS & SPORTS MEDICINE
Authorized official
TERRY GEMAS (MANAGER)
(469) 341-5676
Entity
Organization
Contact information
Practice address
1130 BEACHVIEW, SUITE 100, DALLAS, TX 75218-3697
(469) 341-5676
(469) 341-5677
Mailing address
1130 BEACHVIEW ST, SUITE 100, DALLAS, TX 75218-3700
(469) 341-5676
(469) 341-5677
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00035Z
MEDICARE GROUP
—
01
—
0031MS
BCBS
—
05
—
176468001
—
TX
01
—
610541200
DOL
TX
Enumeration date
12/28/2006
Last updated
06/07/2013
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