Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 000755 | GA |
NPI | 1114089695 |
---|---|
Provider Name | Dr. Keith David Pfeifer |
First Address | Fort Gordon, GA 30905-5650 |
Second Address | Fort Gordon, GA 30905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 11/12/2007 |