Organization
PROFFER SURGICAL ASSOCIATES, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIANA PROFFER (PHYSICIAN)
(806) 354-4900
Entity
Organization
Contact information
Practice address
1611 WALLACE BLVD, AMARILLO, TX 79106-1799
(806) 354-4900
(806) 352-4987
Mailing address
1611 WALLACE BLVD, AMARILLO, TX 79106-1799
(806) 354-4900
(806) 352-4987
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
K6910
TX
207W00000X
Ophthalmology Physician
K3932
TX
208200000X
Plastic Surgery Physician
M0532
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021NJ
BLUE CROSS BLUE SHIELD
TX
05
—
187148501
—
TX
Enumeration date
07/19/2006
Last updated
07/23/2013
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