Provider Demographics
NPI:1831122910
Name:PLAGA, BRADLEY R (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:R
Last Name:PLAGA
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:PO BOX 5116
Mailing Address - Street 2:810 EAST 23RD
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5116
Mailing Address - Country:US
Mailing Address - Phone:605-331-5890
Mailing Address - Fax:605-336-3974
Practice Address - Street 1:810 E 23RD ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2135
Practice Address - Country:US
Practice Address - Phone:605-331-5890
Practice Address - Fax:605-336-3974
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4056207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD200039666OtherRAILROAD MEDICARE
IA1911107Medicaid
SD6400732Medicaid
200039666Medicare PIN
SDS7289Medicare PIN
SD200039666OtherRAILROAD MEDICARE