Provider Demographics
NPI:1548277924
Name:TENNY, JOHN RAMSEY (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RAMSEY
Last Name:TENNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-1029
Mailing Address - Country:US
Mailing Address - Phone:972-283-8700
Mailing Address - Fax:972-283-8704
Practice Address - Street 1:3503 W WHEATLAND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3461
Practice Address - Country:US
Practice Address - Phone:972-283-8700
Practice Address - Fax:972-283-8704
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0845207X00000X, 207XS0114X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D43UOtherBLUE CROSS BLUE SHIELD
TX1143869-03Medicaid
TX00666XMedicare ID - Type Unspecified
TX1143869-03Medicaid
TXC22542Medicare UPIN
TX8C8452Medicare ID - Type Unspecified