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General NPI Number Information
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NPI Number | 1699817569
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Entity Type | Individual
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Provider Name | DAVID LAWRENCE PFEIFER SA-C
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 625 E. BROADWAY
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City | JACKSON
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State | WY
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Zip | 83001
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Country | US
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Telephone | 208-525-2090
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Fax | 208-525-2662
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Provider Business Mailing Address
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Address Line | PO BOX 13220
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City | JACKSON
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State | WY
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Zip | 83002-3220
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Country | US
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Telephone | 208-525-2090
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Fax | 208-525-2662
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State | WY
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