MEDICARE: MR. DAVID W PLANK PA-C

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	363AM0700X	Medical Physician Assistant	254	WV

General Provider Information

NPI Number	:	1821082793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID W PLANK PA-C

Provider Business Mailing Address
First Line	:	PO BOX 217
Second Line	:
City	:	ROCK CAVE
State	:	WV
Zip	:	26234-0217
Country	:	US
Telephone Number	:	304-924-6262
Fax Number	:	304-924-5460

Provider Business Practice Location Address
First Line	:	ROUTE 4 & 20 S. INTERSECTION
Second Line	:
City	:	ROCK CAVE
State	:	WV
Zip	:	26234
Country	:	US
Telephone Number	:	304-924-6262
Fax Number	:	304-924-5460

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	07/24/2009

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Directions to “ MR. DAVID W PLANK PA-C” Practice Location

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