Organization
RSM PLASTIC SURGERY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KANDICE KING (CREDENTIALING SPECIALIST)
(847) 228-3303
Entity
Organization
Contact information
Practice address
3300 W LAKE MARY BLVD STE 210, LAKE MARY, FL 32746-3499
(863) 899-9736
Mailing address
3300 WEST LAKE MARY BLVD, SUITE 210, LAKE MARY, FL 32746
(407) 632-1010
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
ME136100
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235420886
—
CT
Enumeration date
07/10/2018
Last updated
08/21/2019
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