Healthcare Provider Details

I. General information

NPI: 1932578481
Provider Name (Legal Business Name): VERO COSMETIC SURGERY & MEDISPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 37TH ST SUITE D
VERO BEACH FL
32960-6550
US

IV. Provider business mailing address

1255 37TH ST SUITE D
VERO BEACH FL
32960-6550
US

V. Phone/Fax

Practice location:
  • Phone: 772-562-2400
  • Fax: 772-569-3208
Mailing address:
  • Phone: 772-562-2400
  • Fax: 772-569-3208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM H. FRAZIER M.D.
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 772-562-2400