Provider Demographics
NPI:1114286135
Name:BROBST FACIAL PLASTICS, PLLC
Entity Type:Organization
Organization Name:BROBST FACIAL PLASTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BROBST
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:312-523-8693
Mailing Address - Street 1:4800 HEDGCOXE RD # 250
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2403
Mailing Address - Country:US
Mailing Address - Phone:312-523-8693
Mailing Address - Fax:
Practice Address - Street 1:4800 HEDGCOXE RD # 250
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2403
Practice Address - Country:US
Practice Address - Phone:312-523-8693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2101207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty