| Name | Value |
|---|---|
| PROVIDER TYPE | Allopathic & Osteopathic Physicians |
| CLASSIFICATION | Preventive Medicine |
| DEFINITION | A preventive medicine physician who specializes in the diagnosis and treatment of sports related conditions and injuries. |
| AREA OF SPECIALIZATION | Sports Medicine |
| STATUS | Active |
| VA CODE | V182806 |
| X12 CODE | 2083S0010X |
| SPECIALTY CODE | 84 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5251964 |
| EFFECTIVE DATE/TIME |
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