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NPI 1104137074

OrganizationActive

Snake River Plastic Surgery LLC

NPI 1104137074 · Specialist · Jackson, WY

Provider details

NPI number: 1104137074
Entity type: Organization
Primary specialty: SpecialistOther Service Providers
Authorized official: Michael Gellis, Member
License: 2735A (WY)

Practice location

555 E. Broadway

Suite 212

Jackson, WY 83001

Phone: (307) 733-6077

More WY providers

Mailing address

Po Box 2862

Jackson, WY 83001-2862

Registry dates

Enumerated: 2010-06-25
Last updated: 2010-06-25

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Snake River Plastic Surgery LLC — NPI 1104137074, Jackson, WY | NPI Central