Provider Demographics
NPI:1811314479
Name:CORREA PLASTIC SURGERY PLLC
Entity type:Organization
Organization Name:CORREA PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-779-2778
Mailing Address - Street 1:4850 W PANTHER CREEK DR
Mailing Address - Street 2:#105
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3607
Mailing Address - Country:US
Mailing Address - Phone:832-779-2778
Mailing Address - Fax:832-403-2201
Practice Address - Street 1:4850 W PANTHER CREEK DR
Practice Address - Street 2:#105
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3607
Practice Address - Country:US
Practice Address - Phone:832-779-2778
Practice Address - Fax:832-403-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty