Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Plastic and Reconstructive Surgery |
2086S0122X | 02 | Physician/General Surgery | |
Surgery of the Hand |
2086S0105X | 02 | Physician/General Surgery |
| NPI # | 1023105947 |
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| LBN Legal business name | PLASTIC RECONSTRUCTIVE & COSMETIC SURGERY PC | ||||||||
| Authorized official | KENNETH MARSHALL - (PRESIDENT) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 10/10/2006 | ||||||||
| Last updated | 01/22/2013 - About 13 years ago | ||||||||
| Identifiers |
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