Provider Demographics
NPI:1477322345
Name:GULF COAST PLASTIC SURGERY CENTER, LLC
Entity type:Organization
Organization Name:GULF COAST PLASTIC SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PLASTIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:N
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-476-3223
Mailing Address - Street 1:539 FONTAINE ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2018
Mailing Address - Country:US
Mailing Address - Phone:850-476-3440
Mailing Address - Fax:850-741-5099
Practice Address - Street 1:539 FONTAINE ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2018
Practice Address - Country:US
Practice Address - Phone:850-476-3440
Practice Address - Fax:850-741-5099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty