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NPI Code Detail

MEDICARE: MR. PAUL E. PLUMMER LAT, ATC

MEDICARE: MR. PAUL E. PLUMMER LAT, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer36000951AIN

General Provider Information

NPI Number : 1699760694
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PAUL E. PLUMMER LAT, ATC
Provider Business Mailing Address
First Line : 253 COATSVILLE DR
Second Line :
City : WESTFIELD
State : IN
Zip : 46074-8496
Country : US
Telephone Number : 812-208-2318
Fax Number :
Provider Business Practice Location Address
First Line : 8414 NAAB RD
Second Line : SUITE 110
City : INDIANAPOLIS
State : IN
Zip : 46260-1972
Country : US
Telephone Number : 317-338-7746
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2005
Last Update Date : 05/03/2010

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