Provider Demographics
NPI:1700986346
Name:PFEFFER, KATHLEEN DENISE (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DENISE
Last Name:PFEFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9103 S 1300 W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-6706
Mailing Address - Country:US
Mailing Address - Phone:801-432-8690
Mailing Address - Fax:801-432-8681
Practice Address - Street 1:9103 S 1300 W
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6706
Practice Address - Country:US
Practice Address - Phone:801-432-8690
Practice Address - Fax:801-432-8681
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT181505-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTB58053Medicare UPIN