Healthcare Provider Details

I. General information

NPI: 1760748560
Provider Name (Legal Business Name): SCOTT BENJAMIN PLUMMER DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 E RAYMOND ST
PHOENIX AZ
85040-1935
US

IV. Provider business mailing address

4202 E RAYMOND ST
PHOENIX AZ
85040-1935
US

V. Phone/Fax

Practice location:
  • Phone: 602-437-1488
  • Fax: 602-437-5425
Mailing address:
  • Phone: 602-437-1488
  • Fax: 602-437-5425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number3028
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: