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Contact Information

AZALEA ORTHOPEDIC & SPORTS MEDICINE CLINIC PA
3414 GOLDEN ROAD
TYLER, TX75701
 Phone: 903-939-7500
 Fax: 903-939-7728
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Orthopaedic Surgery

207X00000X 02 Physician/General Surgery
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
Indicates primary specialty

NPI Profile & details for AZALEA ORTHOPEDIC SPORTS MEDICINE CLINIC PA · (Female)

NPI # 1699765107
Status Active
Credentials
Entity Individual
Enumeration date 10/26/2005
Last updated 01/28/2019 - About 7 years ago
Sole proprietor 1 Not specified
Identifiers
  • TX License # 0863040001
  • TX Medicaid 084034001
  • TX Medicaid 084034002
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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