Healthcare Provider Details

I. General information

NPI: 1356322705
Provider Name (Legal Business Name): FLORIAN H PLOCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 NUT TREE RD #190
VACAVILLE CA
95687-4100
US

IV. Provider business mailing address

1020 NUT TREE RD #190
VACAVILLE CA
95687-4100
US

V. Phone/Fax

Practice location:
  • Phone: 707-624-8100
  • Fax: 707-624-8101
Mailing address:
  • Phone: 707-624-8100
  • Fax: 707-624-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberC-35122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: