Healthcare Provider Details

I. General information

NPI: 1588608939
Provider Name (Legal Business Name): ELIZABETH DOROTHY PLONKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 N MCMULLEN BOOTH RD
CLEARWATER FL
33761-2008
US

IV. Provider business mailing address

3131 N MCMULLEN BOOTH RD
CLEARWATER FL
33761-2008
US

V. Phone/Fax

Practice location:
  • Phone: 727-726-8871
  • Fax: 727-726-4943
Mailing address:
  • Phone: 727-726-8871
  • Fax: 727-726-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME48612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: