Healthcare Provider Details

I. General information

NPI: 1902726680
Provider Name (Legal Business Name): AESTHETIC PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 COUNTRY CLUB RD
EUGENE OR
97401-2200
US

IV. Provider business mailing address

244 COUNTRY CLUB RD
EUGENE OR
97401-2200
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-8900
  • Fax: 541-683-5389
Mailing address:
  • Phone: 541-687-8900
  • Fax: 541-683-5389

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: LEE DANIEL
Title or Position: OWNER
Credential: MD
Phone: 541-687-8900