Organization
LIFT AESTHETIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN PHILIP MARSHALL DO (SURGEON/OWNER)
(215) 990-1851
Entity
Organization
Contact information
Practice address
4700 NICOLE CT, MISSOULA, MT 59803-2792
(215) 990-1851
Mailing address
4700 NICOLE CT, MISSOULA, MT 59803-2792
(215) 990-1851
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
35293
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982855334
—
MT
Enumeration date
09/20/2017
Last updated
07/21/2022
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