Organization Name: | FLEMING ISLAND PLASTIC SURGERY, LLC |
NPI Number: | 1245602069 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WILLIAM WALLACE (MANAGER/OWNER) |
Mailing Address: | 1679 Eagle Harbor Pkwy Suite C Fleming Island |
State: | FL US |
Postal Code: | 320034815 |
Phone Number: | 9043480727 |
Fax Number: | 9046219272 |
NPI Enumeration Date: | 10/21/2015 |
NPI Last Update Date: | 12/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2086S0122X |
License Number: | ME107749 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Surgery |
Taxonomy Specialization: | Plastic and Reconstructive Surgery |
Taxonomy Definition: | A surgeon who specializes in plastic and reconstructive surgery. |