Healthcare Provider Details

I. General information

NPI: 1790179331
Provider Name (Legal Business Name): JOHN BLAISE PFLUGI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2015
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S. ILLINOIS AVE SUITE 100
MASON CITY IA
50401-5489
US

IV. Provider business mailing address

621 S. ILLINOIS AVE SUITE 103
MASON CITY IA
50401-5489
US

V. Phone/Fax

Practice location:
  • Phone: 641-428-6900
  • Fax: 641-428-6909
Mailing address:
  • Phone: 641-428-3041
  • Fax: 641-428-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number05241
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number172103
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: