Healthcare Provider Details

I. General information

NPI: 1144436874
Provider Name (Legal Business Name): DAVID W PLANCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS LAKE CHAMPLAIN (CG 57)
FPO UNITED STATES
AP
US

IV. Provider business mailing address

10282 CLAMAGORO CIR
SAN DIEGO CA
92124-3645
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-4494
  • Fax:
Mailing address:
  • Phone: 858-573-8969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: