Provider Demographics
NPI:1518591874
Name:SLC PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:SLC PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:REUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-647-5522
Mailing Address - Street 1:7001 S 900 E STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1700
Mailing Address - Country:US
Mailing Address - Phone:801-647-5522
Mailing Address - Fax:
Practice Address - Street 1:6686 HIGHLAND DRIVE
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:801-647-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty