Provider Demographics
NPI:1396963328
Name:PLATT, RORY (MD APC)
Entity type:Individual
Prefix:DR
First Name:RORY
Middle Name:
Last Name:PLATT
Suffix:
Gender:F
Credentials:MD APC
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 6155
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-6155
Mailing Address - Country:US
Mailing Address - Phone:671-646-1186
Mailing Address - Fax:
Practice Address - Street 1:850 GOVERNOR CARLOS G. CAMACHO ROAD
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3128
Practice Address - Country:US
Practice Address - Phone:671-647-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU332363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUD36222Medicare UPIN
GU0000BDCTBMedicare ID - Type Unspecified