Provider Demographics
NPI:1356479588
Name:GULF COAST PLASTIC SURGERY P A
Entity Type:Organization
Organization Name:GULF COAST PLASTIC SURGERY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PISARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-297-9289
Mailing Address - Street 1:215 OAK DR SOUTH
Mailing Address - Street 2:STE J
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566
Mailing Address - Country:US
Mailing Address - Phone:979-297-9289
Mailing Address - Fax:979-299-1007
Practice Address - Street 1:215 OAK DR SOUTH
Practice Address - Street 2:STE J
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566
Practice Address - Country:US
Practice Address - Phone:979-297-9289
Practice Address - Fax:979-299-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00353NOtherMEDICARE GROUP NUMBER
TX00353NMedicare ID - Type Unspecified