Provider Demographics
NPI:1104167626
Name:PERSONS ORTHOPAEDIC SPORTS MEDICINE AND JOINT REPLACEMENT CENTER, PC
Entity type:Organization
Organization Name:PERSONS ORTHOPAEDIC SPORTS MEDICINE AND JOINT REPLACEMENT CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:PERSONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-410-8954
Mailing Address - Street 1:1005 COMMERCIAL LN
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8149
Mailing Address - Country:US
Mailing Address - Phone:757-410-8954
Mailing Address - Fax:757-410-8963
Practice Address - Street 1:1005 COMMERCIAL LN
Practice Address - Street 2:SUITE 210
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8149
Practice Address - Country:US
Practice Address - Phone:757-410-8954
Practice Address - Fax:757-410-8963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039588174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty