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General NPI Number Information
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NPI Number | 1831592930
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Entity Type | Organization
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Legal Business Name | EASTERN SHORE COSMETIC SURGERY PC
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 7541 CIPRIANO CT
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City | FAIRHOPE
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State | AL
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Zip | 36532-3029
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Country | US
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Telephone | 251-929-7850
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Fax | 251-929-2500
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Provider Business Mailing Address
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Address Line | 7541 CIPRIANO CT
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City | FAIRHOPE
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State | AL
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Zip | 36532-3029
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Country | US
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Telephone | 251-929-7850
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Fax | 251-929-2500
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Authorized Official
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Title or Position | SURGICAL COORDINATOR
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Name | MRS. DENVIA POTTER
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Credential |
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Telephone | 251-929-7850
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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 | 23669
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License Number State | AL
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