MEDICARE: INSTITUTE FOR PLASTIC SURGERY AND

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
1	208200000X	Plastic Surgery Physician	30130	AZ

General Provider Information

NPI Number	:	1659317717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE FOR PLASTIC SURGERY AND

Provider Business Mailing Address
First Line	:	3170 N SWAN RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1227
Country	:	US
Telephone Number	:	520-298-2325
Fax Number	:	520-298-2328

Provider Business Practice Location Address
First Line	:	3170 N SWAN RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1227
Country	:	US
Telephone Number	:	520-298-2325
Fax Number	:	520-298-2328

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CHRISTOPHER THOMAS MALONEY JR.
Credential	:	M.D.
Telephone Number	:	520-298-2325

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	01/29/2008

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