Provider Demographics
NPI:1629678800
Name:POSH PLASTIC AND RECONSTRUCTIVE SURGERY PLLC
Entity Type:Organization
Organization Name:POSH PLASTIC AND RECONSTRUCTIVE SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UZOMA
Authorized Official - Middle Name:BEN
Authorized Official - Last Name:GBULIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:682-400-2152
Mailing Address - Street 1:1021 MATLOCK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3443
Mailing Address - Country:US
Mailing Address - Phone:682-400-2152
Mailing Address - Fax:817-225-2774
Practice Address - Street 1:1021 MATLOCK RD STE 103
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3443
Practice Address - Country:US
Practice Address - Phone:682-400-2152
Practice Address - Fax:817-225-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty