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Organization
RESILIENT PLASTIC SURGERY, PLLC
Active
Organization
RESILIENT PLASTIC SURGERY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE MARTIN SOUTHARD DO (PLASTIC & RECONSTRUCTIVE SURGEON)
(817) 335-6363
Entity
Organization
Contact information
Practice address
800 8TH AVE STE 116, FORT WORTH, TX 76104-2606
(817) 335-6363
Mailing address
800 8TH AVE STE 116, FORT WORTH, TX 76104-2606
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Enumeration date
02/22/2023
Last updated
06/21/2023
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