Provider Demographics
NPI:1912180423
Name:GEORGE M. PLOTKIN, PHD, MD, PA
Entity Type:Organization
Organization Name:GEORGE M. PLOTKIN, PHD, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PLOTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:903-535-6092
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR
Mailing Address - Street 2:904
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1951
Mailing Address - Country:US
Mailing Address - Phone:903-535-6092
Mailing Address - Fax:903-535-6097
Practice Address - Street 1:700 OLYMPIC PLAZA CIR
Practice Address - Street 2:SUITE 904
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1951
Practice Address - Country:US
Practice Address - Phone:903-535-6092
Practice Address - Fax:903-535-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0080KKOtherBLUE CROSS
TXDA3083OtherRAILROAD MEDICARE
TX0080KKOtherBLUE CROSS
TX00727UMedicare PIN