Organization
PURA PLASTIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLIVER POPE SIMMONS MD (OWNER)
(803) 421-9208
Entity
Organization
Contact information
Practice address
5351 SUNSET BLVD, LEXINGTON, SC 29072-9159
(803) 490-7644
(803) 490-7645
Mailing address
5351 SUNSET BLVD, LEXINGTON, SC 29072-9159
(803) 490-7644
(803) 490-7645
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
33186
SC
207YX0602X
Otolaryngic Allergy Physician
33186
SC
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
33186
SC
208200000X
Plastic Surgery Physician
33186
SC
2086S0105X
Surgery of the Hand (Surgery) Physician
33186
SC
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
33186
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
331867
—
SC
Enumeration date
02/22/2016
Last updated
01/13/2017
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