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General NPI Number Information
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NPI Number | 1245596501
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Entity Type | Organization
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Legal Business Name | OSAGE VALLEY PLASTIC SURGERY PC
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 04/11/2012
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Provider Practice Location Address
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Address Line | 985 EXECUTIVE DR
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City | OSAGE BEACH
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State | MO
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Zip | 65065-3496
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Country | US
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Telephone | 573-348-4863
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Fax | 573-348-4965
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Provider Business Mailing Address
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Address Line | 985 EXECUTIVE DR
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City | OSAGE BEACH
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State | MO
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Zip | 65065-3496
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Country | US
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Telephone | 573-348-4863
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Fax | 573-348-4965
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DAVID B HUANG
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Credential | M.D.
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Telephone | 573-348-4863
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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 | MO109950
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License Number State | MO
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