| NPI | 1164048062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANA CONROY Director Of Credentialing 719-542-2470 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2024-11-26 |