Healthcare Provider Details

I. General information

NPI: 1134252463
Provider Name (Legal Business Name): ROBERT NEIL PELAEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E BLOOMINGDALE AVE STE 501
BRANDON FL
33511-8118
US

IV. Provider business mailing address

3207 W CHAPIN AVE
TAMPA FL
33611-2703
US

V. Phone/Fax

Practice location:
  • Phone: 813-699-3995
  • Fax:
Mailing address:
  • Phone: 813-786-7124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME39365
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME39365
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: