Organization Name: | CRANIOFACIAL, RECONSTRUCTIVE AND COSMETIC SURGERY ASSOCIATES, LLC |
NPI Number: | 1447673173 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STONE R THAYER (PRESIDENT) |
Mailing Address: | 6705 Sw 57th Ave Ste 510 South Miami |
State: | FL US |
Postal Code: | 331433644 |
Phone Number: | 7864714299 |
Fax Number: | |
NPI Enumeration Date: | 01/31/2014 |
NPI Last Update Date: | 01/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME114524 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |