Provider Demographics
NPI:1669458360
Name:PLUNKETT, JOSEPH MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:PLUNKETT
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 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-450-6401
Practice Address - Street 1:1549 AIRPORT BLVD STE 200F
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8634
Practice Address - Country:US
Practice Address - Phone:850-416-1885
Practice Address - Fax:850-416-1886
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38302208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065389600Medicaid
AL59168542OtherBLUE CROSS BLUE SHIELD
FL17502OtherBLUE CROSS BLUE SHIELD
FL17502OtherBLUE CROSS BLUE SHIELD
AL59168542OtherBLUE CROSS BLUE SHIELD