Organization
CHESNUT INSTITUTE OF COSMETIC & RECONSTRUCTIVE SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GRAYLING LOVE II (C.O.O.)
(678) 216-2718
Entity
Organization
Contact information
Practice address
510 S COWLEY ST STE 201, SPOKANE, WA 99202-1332
(509) 252-1299
Mailing address
510 S COWLEY ST STE 201, SPOKANE, WA 99202-1332
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
207YS0123X
Facial Plastic Surgery Physician
—
—
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
—
—
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
—
—
208200000X
Plastic Surgery Physician
—
—
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285830166
—
IL
05
—
1598181828
—
UT
05
—
1952636672
—
WA
Enumeration date
02/20/2020
Last updated
03/18/2020
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