Provider Demographics
NPI:1780603738
Name:PLOMARITIS, TITUS JR (MD)
Entity type:Individual
Prefix:
First Name:TITUS
Middle Name:
Last Name:PLOMARITIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 W PIERCE ST STE 6E
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3566
Mailing Address - Country:US
Mailing Address - Phone:575-628-3012
Mailing Address - Fax:575-628-8015
Practice Address - Street 1:2402 W PIERCE ST STE 6E
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3566
Practice Address - Country:US
Practice Address - Phone:575-628-3012
Practice Address - Fax:575-628-8015
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-35521207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200867440AMedicaid
KS200867440AMedicaid
KSKA1610039Medicare PIN