Provider Demographics
NPI:1346236692
Name:PLUMLEY, ERIC JASON (DPM)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JASON
Last Name:PLUMLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 N BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3804
Mailing Address - Country:US
Mailing Address - Phone:513-783-4771
Mailing Address - Fax:513-783-4831
Practice Address - Street 1:3913 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6674
Practice Address - Country:US
Practice Address - Phone:513-783-4771
Practice Address - Fax:513-783-4831
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC497213E00000X
OH36-003356213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3121982Medicaid
NC2430148AMedicare PIN
OHV07411Medicare UPIN
OH3121982Medicaid