Healthcare Provider Details

I. General information

NPI: 1780686162
Provider Name (Legal Business Name): ARTHUR J PEDREGAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 N HABANA AVE SUITE 303
TAMPA FL
33614-7161
US

IV. Provider business mailing address

4710 N HABANA AVE SUITE 303
TAMPA FL
33614-7161
US

V. Phone/Fax

Practice location:
  • Phone: 813-879-7940
  • Fax: 813-878-0670
Mailing address:
  • Phone: 813-879-7940
  • Fax: 813-878-0670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME73301
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME73301
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: