Provider Demographics
NPI:1821237322
Name:PALM BEACH INSTITUTE OF PLASTIC AND RECONSTRUCTIVE SURGERY
Entity Type:Organization
Organization Name:PALM BEACH INSTITUTE OF PLASTIC AND RECONSTRUCTIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAGRASSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-624-0900
Mailing Address - Street 1:600 HERITAGE DR
Mailing Address - Street 2:STE 220
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3000
Mailing Address - Country:US
Mailing Address - Phone:561-624-0090
Mailing Address - Fax:561-627-3006
Practice Address - Street 1:600 HERITAGE DR
Practice Address - Street 2:STE 220
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3000
Practice Address - Country:US
Practice Address - Phone:561-624-0090
Practice Address - Fax:561-627-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-07
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102255208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty