Provider Demographics
NPI:1912259698
Name:LAKE JACKSON PLASTIC SURGERY, PA
Entity type:Organization
Organization Name:LAKE JACKSON PLASTIC SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:YARISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-467-0146
Mailing Address - Street 1:10565 KATY FWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1007
Mailing Address - Country:US
Mailing Address - Phone:713-467-0146
Mailing Address - Fax:713-467-9413
Practice Address - Street 1:215 OAK DR S
Practice Address - Street 2:SUITE J
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5629
Practice Address - Country:US
Practice Address - Phone:979-480-0105
Practice Address - Fax:979-480-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2191261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty