Provider Demographics
NPI:1427287259
Name:PLONSKA, JOANNA MARIA (MD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:MARIA
Last Name:PLONSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-7599
Mailing Address - Fax:303-530-5474
Practice Address - Street 1:6685 GUNPARK DR STE 110
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3343
Practice Address - Country:US
Practice Address - Phone:303-530-3062
Practice Address - Fax:303-530-5474
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR-51485207Q00000X
WY8750A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program