Provider Demographics
NPI:1487184792
Name:WEST MAGNOLIA PLASTIC SURGERY PA
Entity Type:Organization
Organization Name:WEST MAGNOLIA PLASTIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-870-4833
Mailing Address - Street 1:1200 W MAGNOLIA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4488
Mailing Address - Country:US
Mailing Address - Phone:817-870-4833
Mailing Address - Fax:817-870-4893
Practice Address - Street 1:1200 W MAGNOLIA AVE STE 110
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4488
Practice Address - Country:US
Practice Address - Phone:817-870-4833
Practice Address - Fax:817-870-4893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7481208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXW0130911OtherDPS