NPI 1104137074

Snake River Plastic Surgery LLC

Organisation Specialist Jackson, WY

Practice location

Address: 555 E. Broadway Suite 212, Jackson, WY 83001
Phone: (307) 733-6077
Mailing address: PO Box 2862, Jackson, WY 83001-2862

Authorised official

Name: Michael Barry Gellis
Title: Member
Phone: (307) 733-6077

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence 2735A (WY)

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Registry record

NPI: 1104137074
Entity type: Organization
NPI issued: 25 Jun 2010
Record last updated: 25 Jun 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.