Healthcare Provider Details

I. General information

NPI: 1376123737
Provider Name (Legal Business Name): KRISTI PEJO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KRISTI PEJO MD

II. Dates (important events)

Enumeration Date: 04/10/2021
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N MARION ST
TAMPA FL
33602-4914
US

IV. Provider business mailing address

203 N MARION ST
TAMPA FL
33602-4914
US

V. Phone/Fax

Practice location:
  • Phone: 813-474-9804
  • Fax: 813-540-6025
Mailing address:
  • Phone: 813-474-9804
  • Fax: 813-540-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME169283
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: