Provider Demographics
NPI:1912609371
Name:PFAUTSCH, MIRANDA (DO)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:PFAUTSCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SW 62ND BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6030
Mailing Address - Country:US
Mailing Address - Phone:352-376-8211
Mailing Address - Fax:
Practice Address - Street 1:200 SW 62ND BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6030
Practice Address - Country:US
Practice Address - Phone:352-376-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program