MEDICARE: DR. PHILLIP BRADLEY PLOTZ 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	207Q00000X	Family Medicine Physician	202213900	MO
2	207Q00000X	Family Medicine Physician	A063826	CA
3	207Q00000X	Family Medicine Physician	049327	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992753842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP BRADLEY PLOTZ M.D.

Provider Business Mailing Address
First Line	:	3400 DATA DR 1ST
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7956
Country	:	US
Telephone Number	:	916-379-2726
Fax Number	:	916-853-7874

Provider Business Practice Location Address
First Line	:	699 W TEFFT ST
Second Line	:	SUITE A
City	:	NIPOMO
State	:	CA
Zip	:	93444-9289
Country	:	US
Telephone Number	:	805-930-9995
Fax Number	:	805-929-5771

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	09/19/2025

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