Provider Demographics
NPI:1386293256
Name:TROY PLASTIC SURGERY, PLLC
Entity type:Organization
Organization Name:TROY PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:TROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-675-9181
Mailing Address - Street 1:8448 WHITE POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-8634
Mailing Address - Country:US
Mailing Address - Phone:813-675-9181
Mailing Address - Fax:
Practice Address - Street 1:5470 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-2853
Practice Address - Country:US
Practice Address - Phone:813-675-9181
Practice Address - Fax:813-675-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty