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General NPI Number Information
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NPI Number | 1760787626
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Entity Type | Organization
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Legal Business Name | EADES PLASTIC SURGERY PLLC
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Dates
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Enumeration Date | 01/24/2011
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 2940 N SWAN RD 130
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City | TUCSON
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State | AZ
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Zip | 85712-5637
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Country | US
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Telephone | 520-323-6994
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Fax | 520-733-0787
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Provider Business Mailing Address
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Address Line | 2940 N SWAN RD STE 130
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City | TUCSON
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State | AZ
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Zip | 85712-6016
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Country | US
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Telephone | 520-323-6994
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Fax | 520-733-0787
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Authorized Official
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Title or Position | OWNER
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Name | MR. EDWARD EADES
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Credential | MD
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Telephone | 520-323-6994
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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 | 19656
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License Number State | AZ
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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 |
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License Number State |
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