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General NPI Number Information
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NPI Number | 1437479987
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Entity Type | Organization
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Legal Business Name | OLACK PLASTIC SURGERY, PLLC
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 06/07/2010
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Provider Practice Location Address
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Address Line | 10210 N 92ND ST SUITE 307
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4509
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Country | US
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Telephone | 480-860-9333
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Fax | 480-451-3108
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Provider Business Mailing Address
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Address Line | 10210 N 92ND ST SUITE 307
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4509
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Country | US
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Telephone | 480-860-9333
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Fax | 480-451-3108
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES BRIAN OLACK
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Credential | MD
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Telephone | 480-960-9333
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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 |
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License Number State |
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