Individual
TY PFAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
18701 N 67TH AVE, GLENDALE, AZ 85308-7100
(877) 934-9355
Mailing address
18701 N 67TH AVE, GLENDALE, AZ 85308-7100
(877) 934-9355
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
011065
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/09/2021
Last updated
05/07/2026
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