Provider Demographics
NPI:1063396257
Name:PLASTIC SURGERY ASSOCIATES OF MS
Entity type:Organization
Organization Name:PLASTIC SURGERY ASSOCIATES OF MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEGENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-936-0936
Mailing Address - Street 1:114 MARKET ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-3340
Mailing Address - Country:US
Mailing Address - Phone:601-936-0936
Mailing Address - Fax:601-936-0936
Practice Address - Street 1:114 MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-3340
Practice Address - Country:US
Practice Address - Phone:601-936-0936
Practice Address - Fax:601-936-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty