Organization
SOMA PLASTIC SURGERY AND HAND CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA MONIQUE OSWALD MD (OWNER)
(601) 914-0732
Entity
Organization
Contact information
Practice address
2630 COURTHOUSE CIR STE A, FLOWOOD, MS 39232-9562
(601) 914-0732
(601) 914-5598
Mailing address
2630 COURTHOUSE CIR STE A, FLOWOOD, MS 39232-9562
(601) 914-0732
(601) 914-5598
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
18863
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05606851
—
MS
01
—
1467654376
TRICARE
MS
01
—
302I248082
MEDICARE PTAN
MS
01
—
9065378
AETNA
MS
Enumeration date
04/05/2010
Last updated
04/05/2010
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