Provider Demographics
NPI:1487758678
Name:PARKCREST PLASTIC SURGERY
Entity type:Organization
Organization Name:PARKCREST PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:314-569-0130
Mailing Address - Street 1:845 NORTH NEW BALLAS CT.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7083
Mailing Address - Country:US
Mailing Address - Phone:314-569-0130
Mailing Address - Fax:314-569-4072
Practice Address - Street 1:845 NORTH NEW BALLAS CT.
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7083
Practice Address - Country:US
Practice Address - Phone:314-569-0130
Practice Address - Fax:314-569-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6776174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA09814Medicare UPIN