Provider Demographics
NPI:1528499779
Name:FACIAL RECONSTRUCTIVE SURGERY ASSOCIATES, PLLC
Entity type:Organization
Organization Name:FACIAL RECONSTRUCTIVE SURGERY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-362-0138
Mailing Address - Street 1:38 GRAND REGENCY CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1608
Mailing Address - Country:US
Mailing Address - Phone:281-362-0138
Mailing Address - Fax:281-362-7995
Practice Address - Street 1:38 GRAND REGENCY CIR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-1608
Practice Address - Country:US
Practice Address - Phone:281-362-0138
Practice Address - Fax:281-362-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4243174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty