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General NPI Number Information
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NPI Number | 1508838947
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Entity Type | Individual
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Provider Name | DR. MICHAEL PESQUEIRA
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Gender | Male
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6000 W HIGHWAY 98 DERMATOLOGY DEPARTMENT, NAVAL HOSP
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City | PENSACOLA
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State | FL
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Zip | 32512-0001
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Country | US
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Telephone | 850-505-6446
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Fax |
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Provider Business Mailing Address
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Address Line | 1978 JOSHUA DR
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City | CANTONMENT
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State | FL
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Zip | 32533-4533
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Country | US
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Telephone |
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME76984
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License Number State | FL
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