Provider Demographics
NPI:1811969108
Name:PLUENNEKE, ANNE C (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:C
Last Name:PLUENNEKE
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 1:755 S WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624
Mailing Address - Country:US
Mailing Address - Phone:830-997-6535
Mailing Address - Fax:830-997-9695
Practice Address - Street 1:755 S WASHINGTON
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624
Practice Address - Country:US
Practice Address - Phone:830-997-6535
Practice Address - Fax:830-997-9695
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7868207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167358401Medicaid
TX8M8011OtherBCBS
TXI07081Medicare UPIN
TX8B8777Medicare ID - Type Unspecified