Provider Demographics
NPI:1659317717
Name:INSTITUTE FOR PLASTIC SURGERY AND
Entity Type:Organization
Organization Name:INSTITUTE FOR PLASTIC SURGERY AND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:520-298-2325
Mailing Address - Street 1:3170 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1227
Mailing Address - Country:US
Mailing Address - Phone:520-298-2325
Mailing Address - Fax:520-298-2328
Practice Address - Street 1:3170 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1227
Practice Address - Country:US
Practice Address - Phone:520-298-2325
Practice Address - Fax:520-298-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30130208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ71248Medicare ID - Type Unspecified
AZZ102868Medicare PIN