Provider Demographics
NPI:1912109950
Name:WITHERS PLASTIC SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:WITHERS PLASTIC SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:HODGES
Authorized Official - Last Name:WITHERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-799-2525
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 2427
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-799-2525
Mailing Address - Fax:713-799-1879
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 2427
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-799-2525
Practice Address - Fax:713-799-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8488174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID NUMBER
TX00LR59Medicare ID - Type Unspecified
TXB27637Medicare UPIN