MEDICARE: DR. DAVID T PLAXICO M.D

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
1	207KA0200X	Allergy Physician	022621	GA

General Provider Information

NPI Number	:	1760470363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID T PLAXICO M.D

Provider Business Mailing Address
First Line	:	2076 INGLESIDE AVE
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31204-2028
Country	:	US
Telephone Number	:	478-743-9376
Fax Number	:	478-743-4670

Provider Business Practice Location Address
First Line	:	2076 INGLESIDE AVE
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31204-2028
Country	:	US
Telephone Number	:	478-743-9376
Fax Number	:	478-743-4670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	07/09/2007

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