Provider Demographics
NPI:1659634624
Name:EAST ALABAMA PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:EAST ALABAMA PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:AQUADRO
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:334-321-4989
Mailing Address - Street 1:778 N DEAN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-4312
Mailing Address - Country:US
Mailing Address - Phone:334-321-4989
Mailing Address - Fax:
Practice Address - Street 1:778 N DEAN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4312
Practice Address - Country:US
Practice Address - Phone:334-321-4989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-24
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.31455208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty