Provider Demographics
NPI:1184969610
Name:YUMA PLASTIC SURGERY INC
Entity type:Organization
Organization Name:YUMA PLASTIC SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-344-1111
Mailing Address - Street 1:2435 S AVENUE A STE C
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7176
Mailing Address - Country:US
Mailing Address - Phone:928-344-1111
Mailing Address - Fax:928-344-1133
Practice Address - Street 1:2435 S AVENUE A STE C
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7176
Practice Address - Country:US
Practice Address - Phone:928-344-1111
Practice Address - Fax:928-344-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE51843Medicare UPIN