Organization
BREAST RECON SPECIALISTS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON VER HALEN (MD)
(817) 416-8080
Entity
Organization
Contact information
Practice address
7167 COLLEYVILLE BLVD STE 102, COLLEYVILLE, TX 76034-8002
(817) 484-0169
Mailing address
1717 WISTERIA WAY, WESTLAKE, TX 76262-9083
(206) 963-8714
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Enumeration date
07/17/2017
Last updated
08/05/2020
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