Provider Demographics
NPI:1588608939
Name:PLONKA, ELIZABETH DOROTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DOROTHY
Last Name:PLONKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3131 N MCMULLEN BOOTH RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2008
Mailing Address - Country:US
Mailing Address - Phone:727-726-8871
Mailing Address - Fax:727-726-4943
Practice Address - Street 1:3131 N MCMULLEN BOOTH RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2008
Practice Address - Country:US
Practice Address - Phone:727-726-8871
Practice Address - Fax:727-726-4943
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48612207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07686ZMedicare PIN
B82692Medicare UPIN