Healthcare Provider Details

I. General information

NPI: 1174737134
Provider Name (Legal Business Name): CENTRAL TEXAS PLASTIC SURGERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7215 WYOMING SPGS SUITE 200
ROUND ROCK TX
78681-4312
US

IV. Provider business mailing address

7215 WYOMING SPGS SUITE 200
ROUND ROCK TX
78681-4312
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-3755
  • Fax: 512-244-9318
Mailing address:
  • Phone: 512-244-3755
  • Fax: 512-244-9318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberJ0116
License Number StateTX

VIII. Authorized Official

Name: DR. TIMOTHY M MCGEE
Title or Position: OWNER
Credential: M.D.
Phone: 512-244-3755