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General NPI Number Information
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NPI Number | 1881665461
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Entity Type | Individual
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Provider Name | OWEN G PELLER MD
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Gender | Male
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 350 NW 84TH AVE STE 200
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City | PLANTATION
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State | FL
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Zip | 33324-1847
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Country | US
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Telephone | 954-424-4321
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 S UNIVERSITY DR STE 104
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City | DAVIE
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State | FL
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Zip | 33328-3835
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Country | US
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Telephone | 954-746-2012
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Fax | 954-746-2013
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME53245
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License Number State | FL
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