Provider Demographics
NPI:1821082793
Name:PLANK, DAVID W (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:PLANK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:ROCK CAVE
Mailing Address - State:WV
Mailing Address - Zip Code:26234-0217
Mailing Address - Country:US
Mailing Address - Phone:304-924-6262
Mailing Address - Fax:304-924-5460
Practice Address - Street 1:ROUTE 4 & 20 S. INTERSECTION
Practice Address - Street 2:
Practice Address - City:ROCK CAVE
Practice Address - State:WV
Practice Address - Zip Code:26234
Practice Address - Country:US
Practice Address - Phone:304-924-6262
Practice Address - Fax:304-924-5460
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV254363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPLPA18311Medicare ID - Type Unspecified
WVP33548Medicare UPIN
WV2031776Medicare PIN
WV2031772Medicare PIN
WV2031774Medicare PIN
WV2031773Medicare PIN
WV2031775Medicare PIN
WV2031771Medicare PIN