Provider Demographics
NPI:1770599557
Name:PLOG, PAULA L (PA-C)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:L
Last Name:PLOG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 WILSON STREET
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59103
Mailing Address - Country:US
Mailing Address - Phone:406-233-2600
Mailing Address - Fax:406-233-2784
Practice Address - Street 1:2600 WILSON STREET
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:56301
Practice Address - Country:US
Practice Address - Phone:406-234-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT331363AM0700X
NE973363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical