Provider Demographics
NPI:1093810780
Name:PFAFF, GLENN A (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:A
Last Name:PFAFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:102 W PINELOCH AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6100
Mailing Address - Country:US
Mailing Address - Phone:407-447-2273
Mailing Address - Fax:407-218-4621
Practice Address - Street 1:102 W PINELOCH AVE STE 11
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6100
Practice Address - Country:US
Practice Address - Phone:407-447-2273
Practice Address - Fax:407-218-4621
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0037152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067116900Medicaid
110972OtherAETNA US HEALTH
D21606Medicare UPIN
FL47388Medicare ID - Type Unspecified