Provider Demographics
NPI:1962465393
Name:FRISCO PLASTIC SURGERY, P.A.
Entity Type:Organization
Organization Name:FRISCO PLASTIC SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SMART
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:972-334-0400
Mailing Address - Street 1:4401 COIT RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0500
Mailing Address - Country:US
Mailing Address - Phone:972-334-0400
Mailing Address - Fax:972-334-0510
Practice Address - Street 1:4401 COIT RD
Practice Address - Street 2:SUITE 309
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0500
Practice Address - Country:US
Practice Address - Phone:972-334-0400
Practice Address - Fax:972-334-0510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8195208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI10695Medicare UPIN
TX8C0875Medicare ID - Type Unspecified