Provider Demographics
NPI:1093171761
Name:RECONSTRUCTIVE MICROSURGERY AND LYMPHEDEMA ASSOCIATES
Entity Type:Organization
Organization Name:RECONSTRUCTIVE MICROSURGERY AND LYMPHEDEMA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-613-1589
Mailing Address - Street 1:7777 FOREST LN STE B216
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6810
Mailing Address - Country:US
Mailing Address - Phone:214-613-1589
Mailing Address - Fax:214-613-1590
Practice Address - Street 1:7777 FOREST LN STE B216
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6810
Practice Address - Country:US
Practice Address - Phone:214-613-1589
Practice Address - Fax:214-613-1590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN59072086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty