Provider Demographics
NPI:1538145156
Name:PFLAUM, DOUGLAS DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:DAVID
Last Name:PFLAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 W DOUGHTY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55041-1500
Mailing Address - Country:US
Mailing Address - Phone:651-345-2350
Mailing Address - Fax:651-345-2238
Practice Address - Street 1:507 W DOUGHTY ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MN
Practice Address - Zip Code:55041-1500
Practice Address - Country:US
Practice Address - Phone:651-345-2350
Practice Address - Fax:651-345-2238
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27015207Q00000X
WI26415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0113153OtherMEDICA
MH9101008902OtherPREFERRED ONE
118098OtherUCARE
49A85PFOtherBCBS
080123675OtherRAILROAD MEDICARE
MN336370800Medicaid
A93789Medicare UPIN
MH9101008902OtherPREFERRED ONE