Provider Demographics
NPI:1780398503
Name:ANTHONY AESTHETICS FACIAL PLASTIC SURGERY, PLLC
Entity type:Organization
Organization Name:ANTHONY AESTHETICS FACIAL PLASTIC SURGERY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:727-820-3223
Mailing Address - Street 1:1901 DR MARTIN LUTHER KING JR ST N STE B
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4272
Mailing Address - Country:US
Mailing Address - Phone:305-812-2962
Mailing Address - Fax:
Practice Address - Street 1:1901 DR MARTIN LUTHER KING JR ST N STE B
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-4272
Practice Address - Country:US
Practice Address - Phone:305-812-2962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Single Specialty
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic SurgeryGroup - Single Specialty