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General NPI Number Information
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NPI Number | 1467865436
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Entity Type | Organization
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Legal Business Name | SOLOMON CLINIC OF PLASTIC SURGERY, PLLC
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Dates
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Enumeration Date | 06/08/2014
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 1313 N TRAVIS ST SUITE 102
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City | SHERMAN
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State | TX
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Zip | 75092-5165
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Country | US
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Telephone | 903-892-1650
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Fax | 903-892-1645
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Provider Business Mailing Address
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Address Line | 2161 MEADOW VIEW DR
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City | PROSPER
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State | TX
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Zip | 75078-9447
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Country | US
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Telephone | 507-250-7803
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MATTHIAS SOLOMON
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Credential | MD
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Telephone | 507-250-7803
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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 | P3587
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License Number State | TX
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