Provider Demographics
NPI:1326277815
Name:PFEFFERKORN, BRANDEN JAMES (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:BRANDEN
Middle Name:JAMES
Last Name:PFEFFERKORN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1309
Mailing Address - Country:US
Mailing Address - Phone:651-265-0000
Mailing Address - Fax:651-265-0001
Practice Address - Street 1:2004 FORD PKWY # MS 35300A
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1931
Practice Address - Country:US
Practice Address - Phone:651-265-0000
Practice Address - Fax:651-265-0001
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60230535207Q00000X
MN62259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8931384Medicare PIN
WA2023541Medicare PIN