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General NPI Number Information
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NPI Number | 1174836126
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Entity Type | Organization
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Legal Business Name | SURGICAL RENEWAL & AESTHETICS
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Dates
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Enumeration Date | 07/20/2010
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 1900 CYPRESS CREEK RD SUITE 100
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City | CEDAR PARK
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State | TX
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Zip | 78613-3513
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Country | US
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Telephone | 512-535-5554
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Fax | 512-454-5252
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Provider Business Mailing Address
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Address Line | 1900 CYPRESS CREEK RD SUITE 100
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City | CEDAR PARK
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State | TX
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Zip | 78613-3513
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Country | US
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Telephone | 512-535-5554
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Fax | 512-454-5252
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL ANTHONY BERRY
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Credential | M.D.
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Telephone | 512-535-5554
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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 | N1552
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License Number State | TX
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