Provider Demographics
NPI:1265617443
Name:NUVEEN COSMETIC & RECONSTRUCTIVE SURGERY, P.C.
Entity type:Organization
Organization Name:NUVEEN COSMETIC & RECONSTRUCTIVE SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:JON
Authorized Official - Last Name:NUVEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:405-842-6677
Mailing Address - Street 1:2100 NW 63RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-5111
Mailing Address - Country:US
Mailing Address - Phone:405-842-6677
Mailing Address - Fax:405-842-6678
Practice Address - Street 1:2100 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-5111
Practice Address - Country:US
Practice Address - Phone:405-842-6677
Practice Address - Fax:405-842-6678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23411208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKI20492OtherUPIN