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General NPI Number Information
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NPI Number | 1578979902
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Entity Type | Organization
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Legal Business Name | PARAGON PLASTIC SURGERY & MED SPA LLC.
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 1101 MATLOCK RD
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City | MANSFIELD
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State | TX
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Zip | 76063-3442
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Country | US
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Telephone | 817-473-2120
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Fax | 817-887-5233
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Provider Business Mailing Address
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Address Line | 1101 MATLOCK RD
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City | MANSFIELD
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State | TX
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Zip | 76063-3442
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Country | US
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Telephone | 817-473-2120
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Fax | 817-887-5233
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK BISHARA
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Credential | M.D.
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Telephone | 817-473-2120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | N2005
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License Number State | TX
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