Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Plastic and Reconstructive Surgery |
2086S0122X | 02 | Physician/General Surgery |
| NPI Number | 1023530094 |
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| LBN Legal business name | NORTHWEST SURGICAL DEVELOPMENT | ||||
| Authorized official | CHRISTINA GILLETT - (INSURANCE SPECIALIST) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 07/12/2017 | ||||
| Last updated | 07/12/2017 - About 9 years ago | ||||
| Identifiers |
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