# PLASTIC SURGERY OF JUPITER, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134356991
- **Authorized official:** KIM EDWARD KOGER M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (561) 748-1565

## Contact information

- **Practice address:** 4600 MILITARY TRL, SUITE 202, JUPITER, FL 33458-4810
- **Practice address phone:** (561) 748-1565
- **Practice address fax:** (561) 748-1568
- **Mailing address:** 4600 MILITARY TRL, SUITE 202, JUPITER, FL 33458-4810
- **Mailing address phone:** (561) 748-1565
- **Mailing address fax:** (561) 748-1568

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171000000X | Military Health Care Provider | ME75895 | FL | Yes |

## Other

- **Enumeration date:** 06/18/2009
- **Last updated:** 07/09/2009