Provider Demographics
NPI:1104825132
Name:PFEIFLE, JAMES A (PAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:PFEIFLE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:MN
Mailing Address - Zip Code:55395-0718
Mailing Address - Country:US
Mailing Address - Phone:320-485-4803
Mailing Address - Fax:320-485-4499
Practice Address - Street 1:551 4TH ST N
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:MN
Practice Address - Zip Code:55395-0000
Practice Address - Country:US
Practice Address - Phone:320-485-4803
Practice Address - Fax:320-485-4499
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9121363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN686530500Medicaid
MN686530500Medicaid