Provider Demographics
NPI:1518409689
Name:CHRISTOPHER LOW PLASTIC SURGERY PA
Entity Type:Organization
Organization Name:CHRISTOPHER LOW PLASTIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-533-8029
Mailing Address - Street 1:906 NE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3607
Mailing Address - Country:US
Mailing Address - Phone:954-533-8029
Mailing Address - Fax:
Practice Address - Street 1:906 NE 26TH AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3607
Practice Address - Country:US
Practice Address - Phone:954-533-8029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1123352086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL129998Medicaid
FLME112335OtherMEDICAL LICENSE
AL1021249467Medicare PIN