Provider Demographics
NPI:1306645221
Name:SOUTHERN ARIZONA PLASTIC SURGERY, PLLC
Entity type:Organization
Organization Name:SOUTHERN ARIZONA PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WYATT
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-762-9777
Mailing Address - Street 1:1104 N EL DORADO PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4606
Mailing Address - Country:US
Mailing Address - Phone:520-762-9777
Mailing Address - Fax:520-666-3211
Practice Address - Street 1:1104 N EL DORADO PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4606
Practice Address - Country:US
Practice Address - Phone:520-762-9777
Practice Address - Fax:520-666-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty