Healthcare Provider Details

I. General information

NPI: 1891777835
Provider Name (Legal Business Name): CHARLES STEVEN PLIMPTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E THOMAS RD
PHOENIX AZ
85012-3203
US

IV. Provider business mailing address

PO BOX 748860
ATLANTA GA
30374-8860
US

V. Phone/Fax

Practice location:
  • Phone: 602-241-1717
  • Fax: 602-265-7216
Mailing address:
  • Phone: 602-241-1717
  • Fax: 602-265-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20429
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: