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General NPI Number Information
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NPI Number | 1023245966
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Entity Type | Organization
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Legal Business Name | NIRVANA PLASTIC SURGERY, P.A.
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 8208A DEVON CT
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City | MYRTLE BEACH
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State | SC
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Zip | 29572-4178
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Country | US
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Telephone | 843-839-2004
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Fax | 843-839-2011
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Provider Business Mailing Address
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Address Line | 8208A DEVON CT
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City | MYRTLE BEACH
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State | SC
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Zip | 29572-4178
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Country | US
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Telephone | 843-839-2004
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Fax | 843-839-2011
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN DAVID DUFFY
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Credential | M.D.
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Telephone | 843-839-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 31460
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License Number State | SC
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