Provider Demographics
NPI:1760470363
Name:PLAXICO, DAVID T (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:PLAXICO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2076 INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2028
Mailing Address - Country:US
Mailing Address - Phone:478-743-9376
Mailing Address - Fax:478-743-4670
Practice Address - Street 1:2076 INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2028
Practice Address - Country:US
Practice Address - Phone:478-743-9376
Practice Address - Fax:478-743-4670
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
GA022621207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD30479Medicare UPIN