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General NPI Number Information
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NPI Number | 1386675767
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Entity Type | Individual
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Provider Name | EDWARD W PELOTE M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 1905 S 25TH ST SUITE 100
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City | FORT PIERCE
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State | FL
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Zip | 34947-4739
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Country | US
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Telephone | 772-465-9901
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Fax | 772-465-9807
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Provider Business Mailing Address
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Address Line | 1905 S 25TH ST SUITE 100
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City | FORT PIERCE
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State | FL
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Zip | 34947-4739
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Country | US
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Telephone | 772-465-9901
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Fax | 772-465-9807
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME93493
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License Number State | FL
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