MEDICARE: DR. ROBERT DAVID PLUMMER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301008956	MI

General Provider Information

NPI Number	:	1417943838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DAVID PLUMMER PHD

Provider Business Mailing Address
First Line	:	PO BOX 6146
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48608-6146
Country	:	US
Telephone Number	:	989-791-1669
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 N CENTER RD
Second Line	:	STE 4
City	:	SAGINAW
State	:	MI
Zip	:	48638-5581
Country	:	US
Telephone Number	:	989-791-1669
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	07/17/2016

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