Healthcare Provider Details

I. General information

NPI: 1730190018
Provider Name (Legal Business Name): DAVID N. PFOHL, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 N GREEN MOUNT RD SUITE 200
O FALLON IL
62269-1953
US

IV. Provider business mailing address

PO BOX 968
O FALLON IL
62269-0968
US

V. Phone/Fax

Practice location:
  • Phone: 618-624-1860
  • Fax: 618-624-1863
Mailing address:
  • Phone: 618-624-1860
  • Fax: 618-624-1863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JERRIE K WEITH
Title or Position: BUSINESS ADVISOR
Credential: FHFMA
Phone: 618-779-5508