Healthcare Provider Details

I. General information

NPI: 1942356795
Provider Name (Legal Business Name): STEVEN C PLAXE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST ARBOR DRIVE MC 8201
SAN DIEGO CA
92103-8201
US

IV. Provider business mailing address

200 WEST ARBOR DRIVE MC 8201
SAN DIEGO CA
92103-8201
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-8745
  • Fax: 858-657-8666
Mailing address:
  • Phone: 858-657-8745
  • Fax: 858-657-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberG64817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: