Provider Demographics
NPI:1104113018
Name:PLYMALE, VLATKA SPLAJT (DO)
Entity type:Individual
Prefix:MRS
First Name:VLATKA
Middle Name:SPLAJT
Last Name:PLYMALE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5979 DESERT STORM AVE
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5585
Mailing Address - Country:US
Mailing Address - Phone:270-412-8698
Mailing Address - Fax:270-412-8698
Practice Address - Street 1:5979 DESERT STORM AVE
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5585
Practice Address - Country:US
Practice Address - Phone:270-412-8698
Practice Address - Fax:270-412-8698
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002417208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000002417OtherMEDICAL LISCENCE