Basic Information
| Provider Information | |||||||||
| NPI: | 1700049327 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MM PLASTIC SURGERY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1951 N WILMOT RD | ||||||||
| Address2: | BLDG 2 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857128000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207507166 | ||||||||
| FaxNumber: | 5208861929 | ||||||||
| Practice Location | |||||||||
| Address1: | 3170 N SWAN RD | ||||||||
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| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857121227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202982325 | ||||||||
| FaxNumber: | 5202982328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2008 | ||||||||
| LastUpdateDate: | 04/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | MASSEY | ||||||||
| AuthorizedOfficialFirstName: | BRANDON | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 5202982325 | ||||||||
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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 | 208200000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.