Provider Demographics
NPI:1225031792
Name:PLUNKETT, EARL K (MD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:K
Last Name:PLUNKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1633
Mailing Address - Country:US
Mailing Address - Phone:702-384-4394
Mailing Address - Fax:
Practice Address - Street 1:1480 S 7TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1633
Practice Address - Country:US
Practice Address - Phone:702-384-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1594581205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005711005Medicare ID - Type Unspecified
UT005711201Medicare ID - Type Unspecified
UTC96449Medicare UPIN
UT005710905Medicare ID - Type Unspecified