| NPI | 1437405875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY THOMAS MYERS Owner 936-539-8115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX M4387) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX M4387) |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2023-03-07 |