Healthcare Provider Details

I. General information

NPI: 1760787626
Provider Name (Legal Business Name): EADES PLASTIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 N SWAN RD 130
TUCSON AZ
85712-5637
US

IV. Provider business mailing address

2940 N SWAN RD STE 130
TUCSON AZ
85712-6016
US

V. Phone/Fax

Practice location:
  • Phone: 520-323-6994
  • Fax: 520-733-0787
Mailing address:
  • Phone: 520-323-6994
  • Fax: 520-733-0787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number19656
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD EADES
Title or Position: OWNER
Credential: MD
Phone: 520-323-6994