Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 02004968A | IN |
Y | 208600000X | Surgeon | 02004968A | IN |
NPI | 1013201995 |
---|---|
Provider Name | Dr. Reid Robert Pflueger |
First Address | Fort Wayne, IN 46804-4166 |
Second Address | Fort Wayne, IN 46804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2011 |
Last Update Date | 26/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300007412 | (05) | IN |