WEST AVE PLASTIC SURGERY, PA
Medical Practice at Kirby Dr, Houston, TX

License number
Texas P1585
Category
Medical Practice
Type
Specialist
Owner
Name: DR. FORREST SUSSMAN ROTH M.D.
Title: PRESIDENT
Phone: (713) 591-9283
Address
Address
2800 Kirby Dr, Houston, TX 77098
National Provider ID: 1386913317
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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WEST AVE PLASTIC SURGERY, PA

2800 Kirby Dr STE B212, Houston, TX 77098

Status:
Inactive
Industry:
Medical Doctor's Office
Doing business as:
Cameo West Ave<br>Dr. Roth, Plastic Surgeon at West Ave<br>West Ave Plastic Surgery, PA
Registration:
Dec 3, 2010
State ID:
0801351154
Business type:
Professional Association
Member, Director, President:
Forrest S. Roth Member, Director, President, inactive
Agent:
Forrest S Roth,2800 Kirby Dr B212, Houston, TX 77098 (Physical)
TIN:
32043133548

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