Organization
GULF COAST PLASTIC & RECONSTRUCTIVE SURGERY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON R WARD M.D. (PRESIDENT)
(850) 233-3376
Entity
Organization
Contact information
Practice address
106 WESTSIDE DR, DOTHAN, AL 36303-1908
(850) 233-3376
(850) 522-8354
Mailing address
2505 HARRISON AVE, PANAMA CITY, FL 32405-4423
(850) 233-3376
(850) 522-8354
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
APPLYING FOR
—
AL
05
—
APPLYING FOR
—
FL
Enumeration date
02/26/2013
Last updated
03/20/2013
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