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General NPI Number Information
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NPI Number | 1184920787
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Entity Type | Individual
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Provider Name | JOHN MICHAEL PEFFER MD
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Gender | Male
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Dates
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Enumeration Date | 01/31/2011
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 511 N TORCH BLVD BLDG 300
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City | CANNON AFB
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State | NM
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Zip | 88103-5109
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Country | US
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Telephone | 575-784-0287
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Fax |
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Provider Business Mailing Address
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Address Line | 4505 SANDSTONE DR
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City | CLOVIS
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State | NM
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Zip | 88101-1037
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Country | US
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Telephone | 281-222-1861
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 26937
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License Number State | NE
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