Provider Demographics
NPI:1235847054
Name:LIFESCULPT, LLC
Entity Type:Organization
Organization Name:LIFESCULPT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:STARNER
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:615-753-7966
Mailing Address - Street 1:5214 RADIANT LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3174
Mailing Address - Country:US
Mailing Address - Phone:615-753-7966
Mailing Address - Fax:615-915-3436
Practice Address - Street 1:5214 RADIANT LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3174
Practice Address - Country:US
Practice Address - Phone:615-753-7966
Practice Address - Fax:615-915-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty