Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 21532 | AZ |
NPI | 1013907716 |
---|---|
Provider Name | James L Plotnik |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 31/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
465003 | (05) | AZ |
F55755 | (02) | AZ |