Provider Demographics
NPI:1386006237
Name:PLASTIC SURGERY AND BREAST RECONSTRUCTION ASSOCIATION OF NORTH TEXAS
Entity Type:Organization
Organization Name:PLASTIC SURGERY AND BREAST RECONSTRUCTION ASSOCIATION OF NORTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-378-9898
Mailing Address - Street 1:PO BOX 670039
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75367-0039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10830 N CENTRAL EXPY
Practice Address - Street 2:SUITE 120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-1050
Practice Address - Country:US
Practice Address - Phone:214-378-9898
Practice Address - Fax:214-378-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty