Individual
KEITH GERRELL PLUMMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
610 E 24TH ST, TISHOMINGO, OK 73460-3245
(580) 371-2343
(580) 371-2451
Mailing address
610 E 24TH ST, TISHOMINGO, OK 73460-3245
(580) 371-2343
(580) 371-2451
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
794
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100058030B
—
OK
Enumeration date
06/13/2006
Last updated
11/03/2011
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