MEDICARE: JOHN CHARLES PFEFFER M.D.

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	207V00000X	Obstetrics & Gynecology Physician	C400620	CA

General Provider Information

NPI Number	:	1851456602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CHARLES PFEFFER M.D.

Provider Business Mailing Address
First Line	:	1400 FLORIDA AVE
Second Line	:	STE. 207
City	:	MODESTO
State	:	CA
Zip	:	95350-4422
Country	:	US
Telephone Number	:	209-522-1027
Fax Number	:	209-522-7956

Provider Business Practice Location Address
First Line	:	1541 FLORIDA AVE STE 304
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95350-4439
Country	:	US
Telephone Number	:	209-522-1027
Fax Number	:	209-529-5398

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	04/04/2024

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