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NPI Code Detail

MEDICARE: AJG AESTHETICS P L C

MEDICARE: AJG AESTHETICS P L C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208200000XPlastic Surgery PhysicianME0076386FL

General Provider Information

NPI Number : 1134364235
Entity Type Code : Organization
Provider Name (Legal Business Name) : AJG AESTHETICS P L C
Provider Business Mailing Address
First Line : 1515 22ND AVE N
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33704-3113
Country : US
Telephone Number : 727-895-1515
Fax Number : 727-895-1511
Provider Business Practice Location Address
First Line : 1515 22ND AVE N
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33704-3113
Country : US
Telephone Number : 727-895-1515
Fax Number : 727-895-1511
Authorized Official
Title or Position : PRACTICE MANAGER
Name : AMY THOMAS
Credential : RNFA
Telephone Number : 727-895-1515
Provider Enumeration Date : 12/04/2008
Last Update Date : 02/05/2009

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Directions to “AJG AESTHETICS P L C ” Practice Location

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