Provider Demographics
NPI:1992753842
Name:PLOTZ, PHILLIP BRADLEY (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:BRADLEY
Last Name:PLOTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3400 DATA DR 1ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2726
Mailing Address - Fax:916-853-7874
Practice Address - Street 1:699 W TEFFT ST
Practice Address - Street 2:SUITE A
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-9289
Practice Address - Country:US
Practice Address - Phone:805-930-9995
Practice Address - Fax:805-929-5771
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA049327207Q00000X
MO202213900207Q00000X
CAA063826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174556286Medicaid
CA1174556286Medicaid
CACB249733Medicare UPIN
GA08BBXMTMedicare PIN