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General NPI Number Information
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NPI Number | 1790271096
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Entity Type | Organization
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Legal Business Name | RSM PLASTIC SURGERY, PA
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Dates
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Enumeration Date | 07/10/2018
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 3300 W LAKE MARY BLVD STE 210
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City | LAKE MARY
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State | FL
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Zip | 32746-3499
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Country | US
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Telephone | 863-899-9736
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 WEST LAKE MARY BLVD SUITE 210
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City | LAKE MARY
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State | FL
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Zip | 32746
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Country | US
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Telephone | 407-632-1010
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | KANDICE KING
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Credential |
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Telephone | 847-228-3303
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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 | ME136100
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License Number State | FL
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