Provider Demographics
NPI:1760787626
Name:EADES PLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:EADES PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:EADES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-323-6994
Mailing Address - Street 1:2940 N SWAN RD STE 130
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6016
Mailing Address - Country:US
Mailing Address - Phone:520-323-6994
Mailing Address - Fax:520-733-0787
Practice Address - Street 1:2940 N SWAN RD
Practice Address - Street 2:130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5637
Practice Address - Country:US
Practice Address - Phone:520-323-6994
Practice Address - Fax:520-733-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19656208200000X
208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD19656OtherMEDICARE ID
MD19656OtherMEDICARE ID