Provider Demographics
NPI:1114230364
Name:PERSONS PLASTIC SURGERY, INC.
Entity Type:Organization
Organization Name:PERSONS PLASTIC SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PERSONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-283-4012
Mailing Address - Street 1:911 MORAGA RD.
Mailing Address - Street 2:#205
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4500
Mailing Address - Country:US
Mailing Address - Phone:925-283-4012
Mailing Address - Fax:925-283-4847
Practice Address - Street 1:911 MORAGA RD.
Practice Address - Street 2:#205
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4500
Practice Address - Country:US
Practice Address - Phone:925-283-4012
Practice Address - Fax:925-283-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64843208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty