Provider Demographics
NPI:1295065852
Name:JONESBORO PLASTIC SURGERY ASSOCIATES INC
Entity type:Organization
Organization Name:JONESBORO PLASTIC SURGERY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MATT
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-7024
Mailing Address - Street 1:1150 E MATTHEWS AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4346
Mailing Address - Country:US
Mailing Address - Phone:870-336-3190
Mailing Address - Fax:870-930-9377
Practice Address - Street 1:1150 E MATTHEWS AVE
Practice Address - Street 2:STE 201
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4346
Practice Address - Country:US
Practice Address - Phone:870-336-3190
Practice Address - Fax:870-930-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty