MEDICARE: WEST STAR SURGICAL, 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	13777	TX

General Provider Information

NPI Number	:	1427056332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST STAR SURGICAL, P.A.

Provider Business Mailing Address
First Line	:	2150 TRAWOOD DR
Second Line	:	STE A100
City	:	EL PASO
State	:	TX
Zip	:	79935-3322
Country	:	US
Telephone Number	:	915-921-8500
Fax Number	:	915-921-8505

Provider Business Practice Location Address
First Line	:	2150 TRAWOOD DR
Second Line	:	STE A100
City	:	EL PASO
State	:	TX
Zip	:	79935-3322
Country	:	US
Telephone Number	:	915-921-8500
Fax Number	:	915-921-8505

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HENRY PAUL JR.
Credential	:	M.D.
Telephone Number	:	915-921-8500

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	08/22/2020

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