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General NPI Number Information
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NPI Number | 1124168927
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN PLASTIC SURGERY ASSOC., PC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 100 TOWNCENTER SUITE 111
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City | TUSCALOOSA
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State | AL
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Zip | 35406-1832
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Country | US
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Telephone | 205-345-8820
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Fax | 205-345-8842
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Provider Business Mailing Address
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Address Line | 100 TOWNCENTER SUITE 111
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City | TUSCALOOSA
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State | AL
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Zip | 35406-1832
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Country | US
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Telephone | 205-345-8820
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Fax | 205-345-8842
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Authorized Official
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Title or Position | SURGEON
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Name | DR. LUIS R PERNIA
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Credential | M.D.
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Telephone | 205-345-8820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 10631
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License Number State | AL
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