MEDICARE: DRESS RECONSTRUCTIVE SURGERY, P.A.

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	ME87448	FL

General Provider Information

NPI Number	:	1194077099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRESS RECONSTRUCTIVE SURGERY, P.A.

Provider Business Mailing Address
First Line	:	11 RACETRACK RD NE
Second Line	:	STE. E4
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1882
Country	:	US
Telephone Number	:	850-200-4575
Fax Number	:	850-200-4576

Provider Business Practice Location Address
First Line	:	11 RACETRACK RD NE
Second Line	:	STE. E4
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1882
Country	:	US
Telephone Number	:	850-200-4575
Fax Number	:	850-200-4576

Authorized Official
Title or Position	:	OWNER/PLASTIC SURGEON
Name	:	CHRISTOPHER MICHAEL DRESS
Credential	:	M.D.
Telephone Number	:	850-362-6191

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	10/03/2012

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