Provider Demographics
NPI:1184273690
Name:PFEIFFER, RONALD CASPER JR
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:CASPER
Last Name:PFEIFFER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S EDWARDS BLVD UNIT 50
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4584
Mailing Address - Country:US
Mailing Address - Phone:262-903-7012
Mailing Address - Fax:
Practice Address - Street 1:125 E STATE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1915
Practice Address - Country:US
Practice Address - Phone:262-903-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer