Provider Demographics
NPI:1598071730
Name:FLORIDA PLASTIC & RECONSTRUCTIVE SURGERY, LLC
Entity Type:Organization
Organization Name:FLORIDA PLASTIC & RECONSTRUCTIVE SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-897-5444
Mailing Address - Street 1:16357 REDINGTON DR
Mailing Address - Street 2:
Mailing Address - City:REDINGTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1547
Mailing Address - Country:US
Mailing Address - Phone:727-897-5444
Mailing Address - Fax:800-971-3437
Practice Address - Street 1:7855 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1152
Practice Address - Country:US
Practice Address - Phone:727-897-5444
Practice Address - Fax:800-971-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11081261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002903300Medicaid