Provider Demographics
NPI:1780343848
Name:PREMIER PLASTIC AND RECONSTRUCTIVE SURGERY PLLC
Entity type:Organization
Organization Name:PREMIER PLASTIC AND RECONSTRUCTIVE SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:RASKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-491-1210
Mailing Address - Street 1:307 DEVON DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3709
Mailing Address - Country:US
Mailing Address - Phone:415-491-1210
Mailing Address - Fax:888-849-4257
Practice Address - Street 1:7700 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3902
Practice Address - Country:US
Practice Address - Phone:210-575-2876
Practice Address - Fax:888-849-4257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX442357601Medicaid