Healthcare Provider Details

I. General information

NPI: 1154671022
Provider Name (Legal Business Name): ARTHUR J. PEDREGAL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 N HABANA AVE STE 303
TAMPA FL
33614-7151
US

IV. Provider business mailing address

4710 N HABANA AVE STE 303
TAMPA FL
33614-7151
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 TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ARTHUR JOHN PEDREGA;
Title or Position: PRESIDENT
Credential: MD
Phone: 813-879-7940