Provider Demographics
NPI:1740217181
Name:PLAMONDON, ROGER PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:PAUL
Last Name:PLAMONDON
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 1:700 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1927
Mailing Address - Country:US
Mailing Address - Phone:205-933-8101
Mailing Address - Fax:
Practice Address - Street 1:1454 JONES DAIRY RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-6164
Practice Address - Country:US
Practice Address - Phone:205-221-7384
Practice Address - Fax:205-221-7385
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1177103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP99194Medicare UPIN