Provider Demographics
NPI:1760754519
Name:PFAFF, RANDALL M JR (CSCS)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:M
Last Name:PFAFF
Suffix:JR
Gender:M
Credentials:CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S MONACO PKWY
Mailing Address - Street 2:110
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1878
Mailing Address - Country:US
Mailing Address - Phone:719-429-4531
Mailing Address - Fax:
Practice Address - Street 1:1250 S MONACO PKWY
Practice Address - Street 2:110
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1878
Practice Address - Country:US
Practice Address - Phone:719-429-4531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171W00000X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor