Healthcare Provider Details

I. General information

NPI: 1992875405
Provider Name (Legal Business Name): JEANNIE L PFLUM DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 SONOMA AVE SUITE 2A
SANTA ROSA CA
95405-4817
US

IV. Provider business mailing address

1140 SONOMA AVE SUITE 2A
SANTA ROSA CA
95405-4820
US

V. Phone/Fax

Practice location:
  • Phone: 707-526-5034
  • Fax: 707-545-3984
Mailing address:
  • Phone: 707-526-5034
  • Fax: 707-545-3984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A7910
License Number StateCA

VIII. Authorized Official

Name: JEANNIE LEE PFLUM
Title or Position: DOCTOR PRESIDENT
Credential: DO
Phone: 707-526-5034