Provider Demographics
NPI:1508573221
Name:PEARL PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:PEARL PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERSHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-878-9300
Mailing Address - Street 1:145 LILLY ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-878-9300
Mailing Address - Fax:360-878-9666
Practice Address - Street 1:145 LILLY ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-878-9300
Practice Address - Fax:360-878-9666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty