MEDICARE: PERSONS PLASTIC SURGERY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	A64843	CA

General Provider Information

NPI Number	:	1114230364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONS PLASTIC SURGERY, INC.

Provider Business Mailing Address
First Line	:	911 MORAGA RD.
Second Line	:	#205
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4500
Country	:	US
Telephone Number	:	925-283-4012
Fax Number	:	925-283-4847

Provider Business Practice Location Address
First Line	:	911 MORAGA RD.
Second Line	:	#205
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4500
Country	:	US
Telephone Number	:	925-283-4012
Fax Number	:	925-283-4847

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BARBARA LYNN PERSONS
Credential	:	M.D.
Telephone Number	:	925-283-4012

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	01/31/2013

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