Provider Demographics
NPI:1316101876
Name:WAKE PLASTIC SURGERY, PLLC
Entity type:Organization
Organization Name:WAKE PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:STOECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-600-0743
Mailing Address - Street 1:1820 CROSSROADS VISTA DR
Mailing Address - Street 2:APARTMENT #203
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4199
Mailing Address - Country:US
Mailing Address - Phone:919-600-0743
Mailing Address - Fax:
Practice Address - Street 1:300 KEISLER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7083
Practice Address - Country:US
Practice Address - Phone:919-805-3441
Practice Address - Fax:919-869-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200701681261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical