Provider Demographics
NPI:1477638492
Name:PLOSS, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:PLOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6980
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-6980
Mailing Address - Country:US
Mailing Address - Phone:707-444-8300
Mailing Address - Fax:707-444-8349
Practice Address - Street 1:2332 23RD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3231
Practice Address - Country:US
Practice Address - Phone:707-444-8300
Practice Address - Fax:707-444-8349
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG066128207RC0000X, 207RC0001X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0077000Medicaid
CAZZZ00763ZMedicare ID - Type UnspecifiedMEDICARE ID#
CAE75101Medicare UPIN