| Organization Name: | CANYON CREEK PLASTIC SURGERY |
| NPI Number: | 1356693840 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEBBIE JOHNS (BILLING MANAGER) |
| Mailing Address: | 576 Kokopelli Blvd Ste D Fruita |
| State: | CO US |
| Postal Code: | 815216304 |
| Phone Number: | 9708582595 |
| Fax Number: | |
| NPI Enumeration Date: | 10/08/2012 |
| NPI Last Update Date: | 10/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0122X |
| License Number: | DR0051737 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| 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. |