Provider Demographics
NPI:1578537221
Name:PFEIFFER, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:PFEIFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3650 CLAYPOND RD
Mailing Address - Street 2:SUITE 408
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-7326
Mailing Address - Country:US
Mailing Address - Phone:843-236-9000
Mailing Address - Fax:
Practice Address - Street 1:3650 CLAYPOND RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-7326
Practice Address - Country:US
Practice Address - Phone:843-236-9000
Practice Address - Fax:407-566-1604
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL74805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA79962Medicare UPIN
FL47144ZMedicare PIN