Active NPI
Gary A Plank, PH.D.
- Psychologist
- Flagstaff, AZ
National Provider Identifier
1518193283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 739
- Practice address
- 3360 E Linda Vista Dr
Flagstaff, AZ 86004-2228 - Phone
- (928) 526-9510
- Fax
- (928) 526-9511
- NPI assigned
- Jun 8, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 739 | NM | Primary |
| Psychologist | 103T00000X | 3456 | AZ |
Addresses
Primary practice location
3360 E Linda Vista Dr
Flagstaff, AZ 86004-2228
Mailing address
3360 E Linda Vista Dr
Flagstaff, AZ 86004-2228
Phone (928) 526-9510
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 739 | NM | MD | Psychologist |
| 3456 | AZ | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244419200000",
"number": "1518193283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3360 E LINDA VISTA DR",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860042228",
"telephone_number": "928-526-9510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3360 E LINDA VISTA DR",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860042228",
"telephone_number": "928-526-9510",
"fax_number": "928-526-9511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PLANK",
"first_name": "GARY",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-08",
"last_updated": "2009-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NM",
"license": "739",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AZ",
"license": "3456",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.