Provider Demographics
NPI:1669629903
Name:SOUTHPOINT PLASTIC SURGERY, PC
Entity Type:Organization
Organization Name:SOUTHPOINT PLASTIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-806-8866
Mailing Address - Street 1:1415 W NC HIGHWAY 54
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5577
Mailing Address - Country:US
Mailing Address - Phone:919-806-8866
Mailing Address - Fax:919-806-8877
Practice Address - Street 1:1415 W NC HIGHWAY 54
Practice Address - Street 2:SUITE 105
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5577
Practice Address - Country:US
Practice Address - Phone:919-806-8866
Practice Address - Fax:919-806-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01037208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty