Organization
PARKCREST PLASTIC SURGERY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBORAH SUE WILLIAMS (OFFICE MANAGER)
(314) 569-9413
Entity
Organization
Contact information
Practice address
845 N. NEW BALLAS COURT, SUITE 300, SAINT LOUIS, MO 63141-7083
(314) 569-9413
(314) 569-3674
Mailing address
845 N. NEW BALLAS COURT, SUITE 300, SAINT LOUIS, MO 63141-7083
(314) 569-9413
(314) 569-3674
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB3594
RR MEDICARE
MO
Enumeration date
12/18/2006
Last updated
03/03/2008
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