GULF COAST PLASTIC & RECONSTRUCTIVE SURGERY INC. NPI 1649510744

NPI Information

  • NPI: 1649510744
  • Provider Name: GULF COAST PLASTIC & RECONSTRUCTIVE SURGERY, INC.
  • Classification: Surgery - 2086S0122X
  • Specialization: Plastic and Reconstructive Surgery
  • Entity Type: Organization
  • CLIA Number: 10D0683249
  • Address: 106 WESTSIDE DR
    DOTHAN, AL
    ZIP 36303
  • Phone: (850) 233-3376

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NPI Details

GULF COAST PLASTIC & RECONSTRUCTIVE SURGERY, INC. is a plastic and reconstructive surgery surgery in Dothan, AL. The provider is a surgeon who specializes in plastic and reconstructive surgery. GULF COAST PLASTIC & RECONSTRUCTIVE SURGERY, INC. NPI is 1649510744. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

106 WESTSIDE DR
DOTHAN, AL
ZIP 36303-908
Phone: (850) 233-3376
Fax: (850) 522-8354

The provider's authorized official is Jon R Ward .
The authorized official title is President and has the following contact phone number (850) 233-3376.

The CLIA number assigned to this NPI record is 10D0683249 - hospital with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 2/26/2013 and was last updated on 3/20/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12086S0122XSurgeryPlastic and Reconstructive SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1APPLYING FORMEDICARE PINALABAMA
2APPLYING FORMEDICAIDALABAMA
3APPLYINGMEDICARE PINFLORIDA
4APPLYING FORMEDICAIDFLORIDA

What is NPI?

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This page was last updated on: 11/21/2025

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