Basic Information
| Provider Information | |||||||||
| NPI: | 1629678800 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POSH PLASTIC AND RECONSTRUCTIVE SURGERY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1021 MATLOCK RD STE 103 | ||||||||
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| City: | MANSFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760633443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6824002152 | ||||||||
| FaxNumber: | 8172252774 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 MATLOCK RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760633443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6824002152 | ||||||||
| FaxNumber: | 8172252774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2020 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| AuthorizedOfficialLastName: | GBULIE | ||||||||
| AuthorizedOfficialFirstName: | UZOMA | ||||||||
| AuthorizedOfficialMiddleName: | BEN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6824002152 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD. | ||||||||
| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
No ID Information.