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General NPI Number Information
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NPI Number | 1073729604
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY CONCEPTS, PC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 10/16/2022
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Provider Practice Location Address
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Address Line | 13131 TESSON FERRY RD SUITE 215
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City | SAINT LOUIS
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State | MO
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Zip | 63128-3887
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Country | US
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Telephone | 314-270-9680
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Fax | 314-270-9681
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Provider Business Mailing Address
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Address Line | 13131 TESSON FERRY RD SUITE 215
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City | SAINT LOUIS
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State | MO
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Zip | 63128-3887
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Country | US
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Telephone | 314-270-9680
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Fax | 314-270-9681
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS V OLIVIER
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Credential | MD
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Telephone | 314-270-9680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 2001004855
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License Number State | MO
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