Healthcare Provider Details

I. General information

NPI: 1578793378
Provider Name (Legal Business Name): HANKINS PLASTIC SURGERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9053 S PECOS RD STE 3000
HENDERSON NV
89074-7179
US

IV. Provider business mailing address

2010 INJO DR
LAKE HAVASU CITY AZ
86403-5707
US

V. Phone/Fax

Practice location:
  • Phone: 928-854-5400
  • Fax:
Mailing address:
  • Phone: 928-854-5400
  • Fax: 928-854-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10829
License Number StateNV

VIII. Authorized Official

Name: WARREN TRACY HANKINS
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 928-854-5400