Healthcare Provider Details

I. General information

NPI: 1558872952
Provider Name (Legal Business Name): C. GUY FPS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 ABERDEEN RD
WACO TX
76712
US

IV. Provider business mailing address

100 W CENTRAL TEXAS EXPY STE 210
HARKER HEIGHTS TX
76548-7469
US

V. Phone/Fax

Practice location:
  • Phone: 245-845-1221
  • Fax: 254-618-1191
Mailing address:
  • Phone: 254-618-4933
  • Fax: 254-618-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberP0727
License Number StateTX

VIII. Authorized Official

Name: CHARLES W GUY
Title or Position: OWNER
Credential: MD
Phone: 254-405-6163