Healthcare Provider Details

I. General information

NPI: 1003885005
Provider Name (Legal Business Name): GAETANO FERNANDO PEREGO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 58TH ST N
CLEARWATER FL
33760-9900
US

IV. Provider business mailing address

14100 58TH ST N
CLEARWATER FL
33760-9900
US

V. Phone/Fax

Practice location:
  • Phone: 727-824-8181
  • Fax:
Mailing address:
  • Phone: 727-824-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036104061
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number155340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: