Healthcare Provider Details

I. General information

NPI: 1649469354
Provider Name (Legal Business Name): BODY SPECTRUM PLASTIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 GREATSTONE PT
LEXINGTON KY
40504-3274
US

IV. Provider business mailing address

2414 GREATSTONE PT
LEXINGTON KY
40504-3274
US

V. Phone/Fax

Practice location:
  • Phone: 859-224-1235
  • Fax: 859-224-2382
Mailing address:
  • Phone: 859-224-1235
  • Fax: 859-224-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BRUCE BARTON
Title or Position: OWNER
Credential: M.D.
Phone: 859-224-1235