Provider Demographics
NPI:1558903146
Name:SIGNATURE PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:SIGNATURE PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-699-3115
Mailing Address - Street 1:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-1148
Mailing Address - Country:US
Mailing Address - Phone:307-699-3115
Mailing Address - Fax:
Practice Address - Street 1:260 N MILLWARD ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8581
Practice Address - Country:US
Practice Address - Phone:307-699-3115
Practice Address - Fax:863-208-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty