MEDICARE: DR. HERBERT ULLMER PEGUES II MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME42698	FL

General Provider Information

NPI Number	:	1295792513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERBERT ULLMER PEGUES II MD

Provider Business Mailing Address
First Line	:	8437 TUTTLE AVE
Second Line	:	362
City	:	SARASOTA
State	:	FL
Zip	:	34243-2868
Country	:	US
Telephone Number	:	941-779-3553
Fax Number	:

Provider Business Practice Location Address
First Line	:	8451 SHADE AVE
Second Line	:	SUITE 206
City	:	SARASOTA
State	:	FL
Zip	:	34243-2878
Country	:	US
Telephone Number	:	941-779-3553
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	06/30/2011

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