Healthcare Provider Details

I. General information

NPI: 1245347004
Provider Name (Legal Business Name): PABLO MARTIN PELLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY STE 801
JACKSONVILLE FL
32216-6292
US

IV. Provider business mailing address

8773 PERIMETER PARK CT
JACKSONVILLE FL
32216-1165
US

V. Phone/Fax

Practice location:
  • Phone: 904-646-3420
  • Fax: 904-646-3017
Mailing address:
  • Phone: 904-493-3390
  • Fax: 904-493-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME64398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: