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General NPI Number Information
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NPI Number | 1659720746
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Entity Type | Organization
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Legal Business Name | DALLAS PLASTIC AND RECONSTRUCTIVE SURGERY ASSOCIATES, PLLC
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 7777 FOREST LN SUITE B116
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City | DALLAS
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State | TX
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Zip | 75230-2571
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Country | US
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Telephone | 972-566-3001
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Fax |
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Provider Business Mailing Address
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Address Line | 7777 FOREST LN SUITE B116
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City | DALLAS
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State | TX
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Zip | 75230-2571
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | EVAN BEALE
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Credential | MD
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Telephone | 972-566-3001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 08618
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | P2995
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License Number State | TX
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