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General NPI Number Information
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NPI Number | 1477519361
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Entity Type | Individual
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Provider Name | ROBERT PENDRAK MD
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Gender | Male
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 10/27/2019
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Provider Practice Location Address
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Address Line | 6500 CRILL AVE
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City | PALATKA
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State | FL
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Zip | 32177-9230
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Country | US
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Telephone | 386-326-0575
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Fax | 386-326-0571
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Provider Business Mailing Address
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Address Line | 6500 CRILL AVE
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City | PALATKA
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State | FL
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Zip | 32177-9230
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Country | US
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Telephone | 386-326-0575
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Fax | 386-326-0571
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD2005-0209
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME85025
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License Number State | FL
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