Provider Demographics
NPI:1427253566
Name:APEX PLASTIC SURGERY PLLC
Entity type:Organization
Organization Name:APEX PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-626-2482
Mailing Address - Street 1:4340 E INDIAN SCHOOL RD
Mailing Address - Street 2:STE 21-496
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5361
Mailing Address - Country:US
Mailing Address - Phone:480-626-2482
Mailing Address - Fax:480-304-9360
Practice Address - Street 1:5656 S. POWER RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8491
Practice Address - Country:US
Practice Address - Phone:480-626-2482
Practice Address - Fax:480-304-9360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ925224Medicaid
AZ104682Medicare ID - Type UnspecifiedMEDICARE GROUP ID