Snake River Plastic Surgery LLC

NPI #1104137074 in Jackson, Wyoming

Provider Information

NPI Number: 1104137074
Entity Type: Organization
Organization Name: Snake River Plastic Surgery LLC
Primary Specialty: Specialist
Enumeration Date: Jun 25, 2010
Last Updated: Jun 25, 2010

Practice Location

Address: 555 E. BROADWAY
Address 2: SUITE 212
City: Jackson
State: Wyoming
ZIP Code: 83001
Phone: (307) 733-6077

Authorized Official

Name: DR. MICHAEL BARRY GELLIS, MD
Title: MEMBER
Phone: (307) 733-6077

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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