Healthcare Provider Details

I. General information

NPI: 1558569087
Provider Name (Legal Business Name): RONALD TODD PLOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12469 TIMBERLAND BLVD STE 501
FORT WORTH TX
76244-6548
US

IV. Provider business mailing address

12469 TIMBERLAND BLVD STE 501
FORT WORTH TX
76244-6548
US

V. Phone/Fax

Practice location:
  • Phone: 817-431-6555
  • Fax:
Mailing address:
  • Phone: 480-206-1064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberH8330
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC53567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: