1487956447 NPI number — MR. ERIC LORENZO PLUNKETT

Table of content: MR. ERIC LORENZO PLUNKETT (NPI 1487956447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487956447 NPI number — MR. ERIC LORENZO PLUNKETT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLUNKETT
Provider First Name:
ERIC
Provider Middle Name:
LORENZO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PLUNKETT
Provider Other First Name:
ERIC
Provider Other Middle Name:
LORENZO
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1487956447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10800 STATE HIGHWAY 151 APT 124
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78251-4209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-647-1907
Provider Business Mailing Address Fax Number:
210-647-1810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10800 STATE HIGHWAY 151 APT 124
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78251-4209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-647-1907
Provider Business Practice Location Address Fax Number:
210-647-1810
Provider Enumeration Date:
11/24/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246ZC0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)