Basic Information
| Provider Information | |||||||||
| NPI: | 1518409689 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHRISTOPHER LOW PLASTIC SURGERY PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 906 NE 26TH AVE | ||||||||
| Address2: | |||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333043607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545338029 | ||||||||
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| Practice Location | |||||||||
| Address1: | 906 NE 26TH AVE | ||||||||
| Address2: | |||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333043607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545338029 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2016 | ||||||||
| LastUpdateDate: | 11/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | LOW | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9545338029 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | ME112335 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 129998 | 05 | AL | MEDICAID | ME112335 | 01 | FL | MEDICAL LICENSE | OTHER |