Provider Demographics
NPI:1982676946
Name:PLOSKER, LARRY (DO)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:PLOSKER
Suffix:
Gender:M
Credentials:DO
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 27340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-7340
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3000
Practice Address - Street 1:19829 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4001
Practice Address - Country:US
Practice Address - Phone:623-879-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ285652Medicaid
AZ1Z7086OtherHEALTH NET OF AZ
AZAZ0221810OtherBCBSAZ
AZZ121424Medicare PIN
AZAZ0221810OtherBCBSAZ
AZ1Z7086OtherHEALTH NET OF AZ
AZZ30WCHLX1GMedicare PIN
AZZ121167Medicare PIN
AZP00310142Medicare PIN
C98290Medicare UPIN
AZZ30WCHLZ1GMedicare PIN
AZ300041154Medicare PIN
AZZ30WCHQV1GMedicare PIN