Healthcare Provider Details

I. General information

NPI: 1013201995
Provider Name (Legal Business Name): REID ROBERT PFLUEGER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 W JEFFERSON BLVD STE 200
FORT WAYNE IN
46804
US

IV. Provider business mailing address

7920 W JEFFERSON BLVD STE 200
FORT WAYNE IN
46804-4166
US

V. Phone/Fax

Practice location:
  • Phone: 260-490-7111
  • Fax:
Mailing address:
  • Phone: 260-490-7111
  • Fax: 260-490-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number02004968A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: