Provider Demographics
NPI:1073393989
Name:PLUMP, CLARENCE T JR
Entity Type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:T
Last Name:PLUMP
Suffix:JR
Gender:M
Credentials:
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 13194
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45413-0194
Mailing Address - Country:US
Mailing Address - Phone:937-321-2460
Mailing Address - Fax:
Practice Address - Street 1:6876 GREELEY AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-1794
Practice Address - Country:US
Practice Address - Phone:937-321-2460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty