Provider Demographics
NPI:1518193283
Name:PLANK, GARY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:PLANK
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 1:3360 E LINDA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-2228
Mailing Address - Country:US
Mailing Address - Phone:928-526-9510
Mailing Address - Fax:
Practice Address - Street 1:3360 E LINDA VISTA DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-2228
Practice Address - Country:US
Practice Address - Phone:928-526-9510
Practice Address - Fax:928-526-9511
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM739103T00000X
AZ3456103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist