| NPI | 1932807682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE MARTIN SOUTHARD Plastic & Reconstructive Surgeon 817-335-6363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Additional Taxonomies | 208200000X Plastic Surgery |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2023-06-21 |