Organization
ORTHOPEDIC ASSOCIATES OF DALLAS LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRACY L JACKSON (CEO)
(214) 818-1200
Entity
Organization
Contact information
Practice address
4708 ALLIANCE BLVD, SUITE 310, PLANO, TX 75093-5340
(214) 823-7090
(214) 823-1644
Mailing address
3900 JUNIUS ST, SUITE 500, DALLAS, TX 75246-1615
(214) 823-7090
(214) 823-1644
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
207XX0801X
Orthopaedic Trauma Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
083558901
—
TX
01
—
OOK730
BCBS
TX
Enumeration date
11/18/2011
Last updated
04/19/2012
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