=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710124847
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UTOPIA PLASTIC SURGERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2009
-----------------------------------------------------
Last Update Date | 01/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1121 UPTOWN PARK BLVD STE 16
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77056-3226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-622-2277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1121 UPTOWN PARK BLVD STE 16
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77056-3226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-622-2277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | M.D.
-----------------------------------------------------
Name | FRANKLIN A. ROSE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-622-2277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number | G0027
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------