Provider Demographics
NPI:1376332387
Name:MIDSOUTH PLASTIC SURGERY PLLC
Entity type:Organization
Organization Name:MIDSOUTH PLASTIC SURGERY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDI
Authorized Official - Middle Name:
Authorized Official - Last Name:PUENTE ESPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:346-717-7607
Mailing Address - Street 1:106 N SPRING DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8116
Mailing Address - Country:US
Mailing Address - Phone:346-717-7607
Mailing Address - Fax:
Practice Address - Street 1:365 N PARKWAY STE 200
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2876
Practice Address - Country:US
Practice Address - Phone:731-426-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty