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General NPI Number Information
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NPI Number | 1316090574
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY INSTITUTE, PA
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 03/05/2009
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Provider Practice Location Address
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Address Line | 1 LILE CT STE 100
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6239
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Country | US
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Telephone | 501-224-1859
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Fax | 501-975-2242
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Provider Business Mailing Address
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Address Line | 1 LILE CT STE 100
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6239
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Country | US
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Telephone | 501-224-1859
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Fax | 501-975-2242
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. EDWARD J LOVE
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Credential | MD
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Telephone | 501-224-1859
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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 | E2504
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License Number State | AR
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