Provider Demographics
NPI:1467865436
Name:SOLOMON CLINIC OF PLASTIC SURGERY, PLLC
Entity type:Organization
Organization Name:SOLOMON CLINIC OF PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-250-7803
Mailing Address - Street 1:2161 MEADOW VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9447
Mailing Address - Country:US
Mailing Address - Phone:507-250-7803
Mailing Address - Fax:
Practice Address - Street 1:1313 N TRAVIS ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5165
Practice Address - Country:US
Practice Address - Phone:903-892-1650
Practice Address - Fax:903-892-1645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-08
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3587208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty