Healthcare Provider Details

I. General information

NPI: 1104877729
Provider Name (Legal Business Name): AESTHETIC CENTER FOR COSMETIC & RECONSTRUCTIVE SURGERY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 SW 34TH CIR
OCALA FL
34474-3371
US

IV. Provider business mailing address

3320 SW 34TH CIR
OCALA FL
34474-3371
US

V. Phone/Fax

Practice location:
  • Phone: 352-629-8154
  • Fax: 352-629-5231
Mailing address:
  • Phone: 352-629-8154
  • Fax: 352-629-5231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. JAMES H ROGERS
Title or Position: PARTNER
Credential: M.D.
Phone: 352-629-8154