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General NPI Number Information
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NPI Number | 1992875405
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Entity Type | Organization
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Legal Business Name | JEANNIE L PFLUM DO INC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 1140 SONOMA AVE SUITE 2A
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City | SANTA ROSA
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State | CA
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Zip | 95405-4817
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Country | US
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Telephone | 707-526-5034
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Fax | 707-545-3984
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Provider Business Mailing Address
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Address Line | 1140 SONOMA AVE SUITE 2A
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City | SANTA ROSA
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State | CA
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Zip | 95405-4820
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Country | US
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Telephone | 707-526-5034
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Fax | 707-545-3984
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Authorized Official
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Title or Position | DOCTOR PRESIDENT
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Name | JEANNIE LEE PFLUM
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Credential | DO
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Telephone | 707-526-5034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 20A7910
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License Number State | CA
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