Provider Demographics
NPI:1417943838
Name:PLUMMER, ROBERT DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:PLUMMER
Suffix:
Gender:M
Credentials:PHD
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 6146
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48608-6146
Mailing Address - Country:US
Mailing Address - Phone:989-791-1669
Mailing Address - Fax:
Practice Address - Street 1:1430 N CENTER RD
Practice Address - Street 2:STE 4
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-5581
Practice Address - Country:US
Practice Address - Phone:989-791-1669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008956103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G33402Medicare ID - Type Unspecified
MI0G33402Medicare UPIN