Provider Demographics
NPI:1093810780
Name:PFAFF, GLENN A (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:A
Last Name:PFAFF
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7300 SANDLAKE COMMONS BLVD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819
Mailing Address - Country:US
Mailing Address - Phone:407-352-1588
Mailing Address - Fax:407-352-9823
Practice Address - Street 1:7300 SANDLAKE COMMONS BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819
Practice Address - Country:US
Practice Address - Phone:407-352-1588
Practice Address - Fax:407-352-9823
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2012-02-02
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Provider Licenses
StateLicense IDTaxonomies
FLME0037152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067116900Medicaid
110972OtherAETNA US HEALTH
D21606Medicare UPIN
FL47388Medicare ID - Type Unspecified