Provider Demographics
NPI:1205827938
Name:PFEIFFER, TIMOTHY OWEN (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:OWEN
Last Name:PFEIFFER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6739 W COLUMBINE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381
Mailing Address - Country:US
Mailing Address - Phone:623-487-7028
Mailing Address - Fax:
Practice Address - Street 1:13677 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2618
Practice Address - Country:US
Practice Address - Phone:623-882-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3394207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZA1U1436OtherHEALTHNET GROUP #
3981220OtherEYECARE GRP #
AZAZ0728670OtherBLUE CROSS BLUE SHIELD
AZ457623Medicaid
AZAZ0728670OtherBLUE CROSS BLUE SHIELD
AZ103813Medicare ID - Type Unspecified