Healthcare Provider Details

I. General information

NPI: 1255362273
Provider Name (Legal Business Name): DOUGLAS P PLOWMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N 500 E
LOGAN UT
84341
US

IV. Provider business mailing address

PO BOX 25535
SALT LAKE CITY UT
84125
US

V. Phone/Fax

Practice location:
  • Phone: 435-716-1000
  • Fax:
Mailing address:
  • Phone: 866-898-7136
  • Fax: 616-975-9824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number2643191205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier930117174
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier5296186401001
Identifier TypeOTHER
Identifier State
Identifier IssuerBCBS
# 3
IdentifierD0310
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer
# 4
Identifier806339800
Identifier TypeMEDICAID
Identifier StateID
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: