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General NPI Number Information
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NPI Number | 1295561207
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Entity Type | Organization
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Legal Business Name | RESTORE PLASTIC AND RECONSTRUCTIVE SURGERY PLLC
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 909 9TH AVE STE 204
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City | FORT WORTH
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State | TX
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Zip | 76104-3916
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Country | US
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Telephone | 915-373-4338
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Fax |
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Provider Business Mailing Address
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Address Line | 909 9TH AVE STE 204
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City | FORT WORTH
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State | TX
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Zip | 76104-3916
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Country | US
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Telephone | 915-373-4338
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN EDWARD MAPULA
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Credential | MD
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Telephone | 915-373-4338
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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 |
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License Number State |
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