Provider Demographics
NPI:1992394548
Name:PLUCER, MARK GERRY
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:GERRY
Last Name:PLUCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8485HIGHGROVECOURT
Mailing Address - Street 2:
Mailing Address - City:GRANDBLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9585
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8485HIGHGROVECOURT
Practice Address - Street 2:
Practice Address - City:GRANDBLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-9585
Practice Address - Country:US
Practice Address - Phone:810-636-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006481207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine