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General NPI Number Information
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NPI Number | 1699961193
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY & WEIGHT LOSS CNTR
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 10994 HISTORIC HIGHWAY 165 STE D
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City | HOLLISTER
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State | MO
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Zip | 65672-5606
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Country | US
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Telephone | 417-239-0079
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Fax | 417-239-1228
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Provider Business Mailing Address
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Address Line | PO BOX 8781
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City | SPRINGFIELD
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State | MO
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Zip | 65801-8781
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Country | US
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Telephone | 417-239-0079
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Fax | 417-239-1228
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Authorized Official
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Title or Position | OFFICER
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Name | DR. MARIAN W STEWART
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Credential | DO
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Telephone | 417-239-0079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 101644
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License Number State | MO
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