Organization
REGENCY RECONSTRUCTION PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON MUSSMAN MD (OWNER)
(989) 255-4794
Entity
Organization
Contact information
Practice address
10240 W INDIAN SCHOOL RD STE 115, PHOENIX, AZ 85037-5905
(623) 251-6431
Mailing address
10240 W INDIAN SCHOOL RD STE 115, PHOENIX, AZ 85037-5905
(623) 251-6431
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
961095
—
AZ
Enumeration date
09/14/2018
Last updated
06/11/2019
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