MEDICARE: DR. GLENN A. PFAFF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47388	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1104222769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. GLENN A. PFAFF

Provider Business Mailing Address
First Line	:	7300 SANDLAKE COMMONS BLVD STE 315
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-8011
Country	:	US
Telephone Number	:	407-352-1588
Fax Number	:	407-352-9823

Provider Business Practice Location Address
First Line	:	7300 SANDLAKE COMMONS BLVD STE 315
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-8011
Country	:	US
Telephone Number	:	407-352-1588
Fax Number	:	407-352-9823

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. GLENN ALBIN PFAFF
Credential	:	M.D.
Telephone Number	:	407-352-1588

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	11/10/2014

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