Provider Demographics
NPI:1114007648
Name:PLYMALE, WILLIAM J JR (PAC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:PLYMALE
Suffix:JR
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 QUAIL RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-4348
Mailing Address - Country:US
Mailing Address - Phone:402-223-3051
Mailing Address - Fax:402-489-3249
Practice Address - Street 1:1500 S 48TH ST
Practice Address - Street 2:SUITE 605
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1276
Practice Address - Country:US
Practice Address - Phone:402-489-7100
Practice Address - Fax:402-489-3249
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE150363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39305OtherBLUE CROSS BLUE SHIELD
NE281975Medicare PIN