Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 28352 | CO |
NPI | 1003813270 |
---|---|
Provider Name | Dr. Lyle M Pfeifer |
First Address | Longmont, CO 80501-3128 |
Second Address | Longmont, CO 80501-3128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2005 |
Last Update Date | 09/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01283522 | (05) | CO |
E46308 | (02) |