Provider Demographics
NPI:1295561207
Name:RESTORE PLASTIC AND RECONSTRUCTIVE SURGERY PLLC
Entity type:Organization
Organization Name:RESTORE PLASTIC AND RECONSTRUCTIVE SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MAPULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-373-4338
Mailing Address - Street 1:909 9TH AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3916
Mailing Address - Country:US
Mailing Address - Phone:915-373-4338
Mailing Address - Fax:
Practice Address - Street 1:909 9TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3916
Practice Address - Country:US
Practice Address - Phone:915-373-4338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty