Provider Demographics
NPI:1508421819
Name:PHOENIX PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:PHOENIX PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONI
Authorized Official - Middle Name:B
Authorized Official - Last Name:PRUCZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-625-0003
Mailing Address - Street 1:7575 E REDFIELD RD STE 235
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3929
Mailing Address - Country:US
Mailing Address - Phone:304-685-9808
Mailing Address - Fax:
Practice Address - Street 1:9250 N 3RD ST STE 1003
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2402
Practice Address - Country:US
Practice Address - Phone:602-331-7811
Practice Address - Fax:833-807-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty