=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730172479
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRANCIS B PELLEGRINO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2005
-----------------------------------------------------
Last Update Date | 01/31/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1745 E HWY 50 SUITE C
-----------------------------------------------------
City | CLERMONT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34711-5037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-394-8060
-----------------------------------------------------
Fax | 352-708-6420
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18550 US HIGHWAY 441 STE A
-----------------------------------------------------
City | MOUNT DORA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32757-6751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-992-6658
-----------------------------------------------------
Fax | 352-503-0663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME55766
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------