Provider Demographics
NPI:1194763987
Name:PLANTZ, ROBERT WILLIAM (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:PLANTZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:MIDPINES
Mailing Address - State:CA
Mailing Address - Zip Code:95345-0047
Mailing Address - Country:US
Mailing Address - Phone:440-590-3626
Mailing Address - Fax:
Practice Address - Street 1:4932 PONDEROSA WAY
Practice Address - Street 2:
Practice Address - City:MIDPINES
Practice Address - State:CA
Practice Address - Zip Code:95345-9705
Practice Address - Country:US
Practice Address - Phone:440-590-3626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18382363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18382OtherPAC LIC.
1067187OtherNCCPA CERTIFICATION
OH50-002416OtherOH MEDICAL BOARD REGIST