Organization
KEYSTONE PLASTIC RECONSTRUCTIVE SURGERY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS O SHANNON MD (GENERAL MANAGER)
(936) 321-4345
Entity
Organization
Contact information
Practice address
3115 COLLEGE PARK DR, SUITE 101, THE WOODLANDS, TX 77384-4000
(936) 321-4345
(936) 321-4353
Mailing address
3115 COLLEGE PARK DR, SUITE 101, THE WOODLANDS, TX 77384-4000
(936) 321-4345
(936) 321-4353
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080725701
—
TX
Enumeration date
05/04/2007
Last updated
09/16/2015
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