Provider Demographics
NPI:1932454881
Name:LEY INSTITUTE OF PLASTIC & HAND SURGERY, LLC
Entity type:Organization
Organization Name:LEY INSTITUTE OF PLASTIC & HAND SURGERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEAZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:LEY TAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-651-8782
Mailing Address - Street 1:5225 E KNIGHT DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2156
Mailing Address - Country:US
Mailing Address - Phone:520-396-3566
Mailing Address - Fax:801-396-3548
Practice Address - Street 1:1517 N WILMOT RD
Practice Address - Street 2:177
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4410
Practice Address - Country:US
Practice Address - Phone:520-396-3566
Practice Address - Fax:801-396-3548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36876261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ701121OtherAHCCCS