Provider Demographics
NPI:1073785929
Name:HALL AND WRYE PLASTIC SURGEONS, LTD
Entity Type:Organization
Organization Name:HALL AND WRYE PLASTIC SURGEONS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:775-284-8296
Mailing Address - Street 1:635 SIERRA ROSE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2060
Mailing Address - Country:US
Mailing Address - Phone:775-284-8296
Mailing Address - Fax:775-332-6583
Practice Address - Street 1:635 SIERRA ROSE DR
Practice Address - Street 2:SUITE A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2060
Practice Address - Country:US
Practice Address - Phone:775-284-8296
Practice Address - Fax:775-332-6583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016802Medicaid
NV2016842Medicaid
NV2016842Medicaid
G90622Medicare UPIN
H2389Medicare UPIN