Provider Demographics
NPI:1508848474
Name:PLUMMER, PATRICK MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MARTIN
Last Name:PLUMMER
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 1:2586 LAUREN DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-5301
Mailing Address - Country:US
Mailing Address - Phone:208-249-4050
Mailing Address - Fax:
Practice Address - Street 1:2586 LAUREN DR
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-5301
Practice Address - Country:US
Practice Address - Phone:208-249-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-9673207YS0012X
ORMD16163207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003424000Medicaid
OR096198Medicaid
OR096198Medicaid
ORE96965Medicare UPIN