Provider Demographics
NPI:1750418679
Name:JOSEPH PLASTIC SURGERY, PLC
Entity type:Organization
Organization Name:JOSEPH PLASTIC SURGERY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-673-3223
Mailing Address - Street 1:340 N WYMORE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2823
Mailing Address - Country:US
Mailing Address - Phone:407-673-3223
Mailing Address - Fax:407-772-3223
Practice Address - Street 1:340 N WYMORE RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2823
Practice Address - Country:US
Practice Address - Phone:407-673-3223
Practice Address - Fax:407-772-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64574174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4248Medicare ID - Type Unspecified