Provider Demographics
NPI:1396892790
Name:PLASTIC SURGERY SPECIALISTS, PC
Entity type:Organization
Organization Name:PLASTIC SURGERY SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DOYLE
Authorized Official - Last Name:MERKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-242-9127
Mailing Address - Street 1:2525 N 8TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8847
Mailing Address - Country:US
Mailing Address - Phone:970-242-9127
Mailing Address - Fax:970-242-8304
Practice Address - Street 1:2525 N 8TH ST STE 203
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8847
Practice Address - Country:US
Practice Address - Phone:970-242-9127
Practice Address - Fax:970-242-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16074174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00160746Medicaid
CO62681Medicare ID - Type UnspecifiedMEDICARE
CO00160746Medicaid
COD22979Medicare UPIN