| NPI | 1093228587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISSA HARRELL Owner 727-781-0818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck | |
| 208200000X Plastic Surgery | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck | |
| 2082S0105X Plastic Surgery, Surgery of the Hand | |
| 261QA1903X Clinic/Center, Ambulatory Surgical | |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2019-02-20 |