Healthcare Provider Details

I. General information

NPI: 1407351869
Provider Name (Legal Business Name): WINSTON J PLUNKETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CHESTERFIELD HWY
CHERAW SC
29520-7001
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-537-2171
  • Fax: 843-537-5926
Mailing address:
  • Phone: 843-537-2171
  • Fax: 843-537-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11405459-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number85727
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: