Basic Information
| Provider Information | |||||||||
| NPI: | 1992875405 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JEANNIE L PFLUM DO INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WOMEN'S HEALTH WITH DR JEANNIE PFLUM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 SONOMA AVE | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954054820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075265034 | ||||||||
| FaxNumber: | 7075453984 | ||||||||
| Practice Location | |||||||||
| Address1: | 1140 SONOMA AVE | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954054817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075265034 | ||||||||
| FaxNumber: | 7075453984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 07/11/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PFLUM | ||||||||
| AuthorizedOfficialFirstName: | JEANNIE | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7075265034 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 20A7910 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00AY79100 | 05 | CA | MEDICAID |