Provider Demographics
NPI:1861569915
Name:PLUNKETT, DANIEL KENT (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:KENT
Last Name:PLUNKETT
Suffix:
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 1:609 TALLAHATCHIE ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2005
Mailing Address - Country:US
Mailing Address - Phone:662-453-5208
Mailing Address - Fax:662-453-4546
Practice Address - Street 1:609 TALLAHATCHIE ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2005
Practice Address - Country:US
Practice Address - Phone:662-453-5208
Practice Address - Fax:662-453-4546
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13905207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119361Medicaid
MS00119361Medicaid