Healthcare Provider Details

I. General information

NPI: 1144638834
Provider Name (Legal Business Name): HIGH POINT PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2014
Last Update Date: 07/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 MILITARY TRL #204
JUPITER FL
33458-5009
US

IV. Provider business mailing address

3535 MILITARY TRL #204
JUPITER FL
33458-5009
US

V. Phone/Fax

Practice location:
  • Phone: 617-721-5891
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME104001
License Number StateFL

VIII. Authorized Official

Name: JASON S COOPER
Title or Position: OWNER
Credential: MD
Phone: 617-721-5891