Provider Demographics
NPI:1104877729
Name:AESTHETIC CENTER FOR COSMETIC & RECONSTRUCTIVE SURGERY, LLP
Entity type:Organization
Organization Name:AESTHETIC CENTER FOR COSMETIC & RECONSTRUCTIVE SURGERY, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-629-8154
Mailing Address - Street 1:3320 SW 34TH CIR
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-3371
Mailing Address - Country:US
Mailing Address - Phone:352-629-8154
Mailing Address - Fax:352-629-5231
Practice Address - Street 1:3320 SW 34TH CIR
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3371
Practice Address - Country:US
Practice Address - Phone:352-629-8154
Practice Address - Fax:352-629-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45866Medicare PIN