Provider Demographics
NPI:1144638834
Name:HIGH POINT PLASTIC SURGERY, LLC
Entity type:Organization
Organization Name:HIGH POINT PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:S
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-721-5891
Mailing Address - Street 1:3535 MILITARY TRL
Mailing Address - Street 2:#204
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3535 MILITARY TRL
Practice Address - Street 2:#204
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5009
Practice Address - Country:US
Practice Address - Phone:617-721-5891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104001208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty