Provider Demographics
NPI:1255415790
Name:EPPLEY PLASTIC SURGERY PC
Entity type:Organization
Organization Name:EPPLEY PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:EPPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:317-814-4100
Mailing Address - Street 1:11725 N ILLINOIS ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3008
Mailing Address - Country:US
Mailing Address - Phone:317-814-4100
Mailing Address - Fax:317-217-2205
Practice Address - Street 1:11725 N ILLINOIS ST
Practice Address - Street 2:SUITE 140
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3008
Practice Address - Country:US
Practice Address - Phone:317-814-4100
Practice Address - Fax:317-217-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038976A2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty