Healthcare Provider Details

I. General information

NPI: 1083645717
Provider Name (Legal Business Name): ADVANCED FACIAL COSMETIC & LASER SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5070 HIGHWAY A1A
VERO BEACH FL
32963-1400
US

IV. Provider business mailing address

5070 HIGHWAY A1A
VERO BEACH FL
32963-1400
US

V. Phone/Fax

Practice location:
  • Phone: 772-237-3700
  • Fax: 772-234-3770
Mailing address:
  • Phone: 772-237-3700
  • Fax: 772-234-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FERDINAND F BECKER
Title or Position: PROVIDER
Credential: MD, FACS
Phone: 480-357-3904