Provider Demographics
NPI:1578834644
Name:THAXTON PLASTIC SURGERY
Entity Type:Organization
Organization Name:THAXTON PLASTIC SURGERY
Other - Org Name:STEWART AND THAXTON, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:THAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-925-8949
Mailing Address - Street 1:505 CAPITOL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1204
Mailing Address - Country:US
Mailing Address - Phone:304-925-8949
Mailing Address - Fax:304-925-8953
Practice Address - Street 1:505 CAPITOL ST STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1204
Practice Address - Country:US
Practice Address - Phone:304-925-8949
Practice Address - Fax:304-925-8953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty