Healthcare Provider Details

I. General information

NPI: 1265407720
Provider Name (Legal Business Name): CARL ANDREW PLONSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 S UNION AVE SUITE 1
TACOMA WA
98405-1954
US

IV. Provider business mailing address

1530 S UNION AVE SUITE 1
TACOMA WA
98405-1954
US

V. Phone/Fax

Practice location:
  • Phone: 253-759-3333
  • Fax: 253-759-1415
Mailing address:
  • Phone: 253-759-3333
  • Fax: 253-759-1543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00017861
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: