Provider Demographics
NPI:1184365405
Name:PLEETER, EZRA AVIGDOR (DO)
Entity type:Individual
Prefix:
First Name:EZRA
Middle Name:AVIGDOR
Last Name:PLEETER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 BARTOL AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3901
Mailing Address - Country:US
Mailing Address - Phone:443-829-3696
Mailing Address - Fax:
Practice Address - Street 1:13001 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9203
Practice Address - Country:US
Practice Address - Phone:561-784-3127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program