Healthcare Provider Details

I. General information

NPI: 1124223474
Provider Name (Legal Business Name): BRENT JAMES PFEIFFER M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE HOLTZ CHILDREN'S HOSPITAL, JMH EAST TOWER 6006 (R-131)
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE HOLTZ CHILDREN'S HOSPITAL, JMH EAST TOWER 6006 (R-131)
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6051
  • Fax:
Mailing address:
  • Phone: 305-585-6051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTRN10251
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME 104137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: