Provider Demographics
NPI:1386724565
Name:PLUMB, TODD R (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:R
Last Name:PLUMB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST #800
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:1380 EAST MEDICAL CENTER DRIVE
Practice Address - Street 2:DIXIE REGIONAL MEDICAL CENTER
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-251-1000
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT187469-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ822123Medicaid
UT870545614TP3OtherEDUCATORS MUTUAL
NV002084198Medicaid
WY118903400Medicaid
UT9855OtherHEALTHY U
UT107005496102OtherIHC
UT2090168OtherUNITED HEALTHCARE
UTTPRA07508OtherMOLINA
UT1502954OtherUMWA
UT73622OtherPEHP
UT116293OtherDESERET MUTUAL
ID805388100Medicaid
UTQM0000075886OtherALTIUS
WY118903400Medicaid
UTF42824Medicare UPIN
UT055327123Medicare ID - Type Unspecified