Provider Demographics
NPI:1033271085
Name:BAY AREA PLASTIC SURGERY
Entity Type:Organization
Organization Name:BAY AREA PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:DYAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:251-471-3211
Mailing Address - Street 1:2860 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2478
Mailing Address - Country:US
Mailing Address - Phone:251-471-3211
Mailing Address - Fax:251-471-3475
Practice Address - Street 1:2860 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-2478
Practice Address - Country:US
Practice Address - Phone:251-471-3211
Practice Address - Fax:251-471-3475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherTIN