1194763987 NPI number — MR. ROBERT WILLIAM PLANTZ PA-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194763987 NPI number — MR. ROBERT WILLIAM PLANTZ PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLANTZ
Provider First Name:
ROBERT
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194763987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 47
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDPINES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95345-0047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-590-3626
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4932 PONDEROSA WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDPINES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95345-9705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-590-3626
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2006

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: 363A00000X , with the licence number:  18382 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 18382 . This is a "PAC LIC." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1067187 . This is a "NCCPA CERTIFICATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50-002416 . This is a "OH MEDICAL BOARD REGIST" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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