Healthcare Provider Details

I. General information

NPI: 1821082793
Provider Name (Legal Business Name): DAVID W PLANK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 4 & 20 S. INTERSECTION
ROCK CAVE WV
26234
US

IV. Provider business mailing address

PO BOX 217
ROCK CAVE WV
26234-0217
US

V. Phone/Fax

Practice location:
  • Phone: 304-924-6262
  • Fax: 304-924-5460
Mailing address:
  • Phone: 304-924-6262
  • Fax: 304-924-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number254
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: