Healthcare Provider Details

I. General information

NPI: 1821025073
Provider Name (Legal Business Name): PELAEZ AND MONTANE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1383 PROVIDENCE RD SUITE 102
BRANDON FL
33511-4885
US

IV. Provider business mailing address

1383 PROVIDENCE RD
BRANDON FL
33511-4885
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-5714
  • Fax: 813-689-9557
Mailing address:
  • Phone: 813-681-5714
  • Fax: 813-689-9557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME39365
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME71781
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME58346
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME52110
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT N PELAEZ
Title or Position: CO-OWNER
Credential: MD
Phone: 813-681-5714