Provider Demographics
NPI:1083645717
Name:ADVANCED FACIAL COSMETIC & LASER SURGERY CENTER INC
Entity Type:Organization
Organization Name:ADVANCED FACIAL COSMETIC & LASER SURGERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:FERDINAND
Authorized Official - Middle Name:F
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:480-357-3904
Mailing Address - Street 1:5070 HIGHWAY A1A
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-1400
Mailing Address - Country:US
Mailing Address - Phone:772-237-3700
Mailing Address - Fax:772-234-3770
Practice Address - Street 1:5070 HIGHWAY A1A
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-1400
Practice Address - Country:US
Practice Address - Phone:772-237-3700
Practice Address - Fax:772-234-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71729Medicare PIN