MEDICARE: FLORIDA PLASTIC & RECONSTRUCTIVE SURGERY, LLC

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	261QM2500X	Medical Specialty Clinic/Center	OS11081	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598071730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA PLASTIC & RECONSTRUCTIVE SURGERY, LLC

Provider Business Mailing Address
First Line	:	16357 REDINGTON DR
Second Line	:
City	:	REDINGTON BEACH
State	:	FL
Zip	:	33708-1547
Country	:	US
Telephone Number	:	727-897-5444
Fax Number	:	800-971-3437

Provider Business Practice Location Address
First Line	:	7855 38TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-1152
Country	:	US
Telephone Number	:	727-897-5444
Fax Number	:	800-971-3437

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTOPHER NEWMAN
Credential	:	D.O.
Telephone Number	:	727-897-5444

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	05/16/2016

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