Individual
MATTHEW J PLUMMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
29928 SAINT SIMON ST, DAPHNE, AL 36526-9562
(251) 583-3101
Mailing address
29928 SAINT SIMON ST, DAPHNE, AL 36526-9562
(251) 583-3101
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
PA465
AL
363A00000X
Physician Assistant
PA465
AL
363AS0400X
Surgical Physician Assistant
Primary
PA465
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009937279
—
AL
01
—
1174551873
TRICARE SOUTH
AL
05
—
122065
—
AL
05
—
122069
—
AL
05
—
122071
—
AL
05
—
122073
—
AL
05
—
122739
—
AL
01
—
511-07320
BCBS
AL
01
—
511-07321
BCBS
AL
01
—
511-07322
BCBS
AL
01
—
511-07323
BCBS
AL
Enumeration date
06/29/2006
Last updated
10/01/2010
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