Provider Demographics
NPI:1962070334
Name:PADUCAH PLASTIC AND RECONSTRUCTIVE SURGERY
Entity type:Organization
Organization Name:PADUCAH PLASTIC AND RECONSTRUCTIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:VERBIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-709-1984
Mailing Address - Street 1:2605 KENTUCKY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3800
Mailing Address - Country:US
Mailing Address - Phone:270-709-1984
Mailing Address - Fax:270-933-1047
Practice Address - Street 1:2605 KENTUCKY AVE STE 100
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3800
Practice Address - Country:US
Practice Address - Phone:270-709-1984
Practice Address - Fax:270-933-1047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty