Provider Demographics
NPI:1679563639
Name:PFEFFER, ROBERT DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:PFEFFER
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 1:1117 29TH ST S
Mailing Address - Street 2:STE 200
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5309
Mailing Address - Country:US
Mailing Address - Phone:406-731-8240
Mailing Address - Fax:406-731-8178
Practice Address - Street 1:12410 E SINTO AVE STE B
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2280
Practice Address - Country:US
Practice Address - Phone:509-838-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT66722085R0001X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0142238OtherLABOR & INDUSTRIES
KZ561OtherBLUE CROSS OF IDAHO
P00202524OtherRAILROAD MEDICARE
ID807071800Medicaid
3255PFOtherASURIS NW HEALTH
000010150380OtherBLUE SHIELD OF IDAHO
7670662OtherAETNA
WA8417248Medicaid
3255PFOtherASURIS NW HEALTH
E60616Medicare UPIN