Healthcare Provider Details

I. General information

NPI: 1902844038
Provider Name (Legal Business Name): CENTER FOR PLASTIC & RECONSTRUCTIVE SURGERY A PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N ORANGE AVE STE 815
ORLANDO FL
32801-5203
US

IV. Provider business mailing address

2501 N ORANGE AVENUE SUITE 442
ORLANDO FL
32804
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-1436
  • Fax: 407-898-6330
Mailing address:
  • Phone: 407-898-1436
  • Fax: 407-898-6330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELA L HENRY
Title or Position: OFFICE MANAGER
Credential:
Phone: 407-898-1436