Healthcare Provider Details

I. General information

NPI: 1457371569
Provider Name (Legal Business Name): JAMES W. PLONK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BLYTHE BLVD STE. 500
CHARLOTTE NC
28203-5874
US

IV. Provider business mailing address

1001 BLYTHE BLVD STE. 500
CHARLOTTE NC
28203-5874
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-5100
  • Fax: 704-342-4354
Mailing address:
  • Phone: 704-355-5100
  • Fax: 704-342-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number15992
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: