MEDICARE: LUZ E PEGUERO M.D.

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	207R00000X	Internal Medicine Physician	217674	NY
2	207R00000X	Internal Medicine Physician	ME107520	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	53099A	OTHER	NY	MEDICARE PIN
2	331833	OTHER	NY	MEDICARE OSCAR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760469654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ E PEGUERO M.D.

Provider Business Mailing Address
First Line	:	601 S HARBOUR ISLAND BLVD STE 200
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-5925
Country	:	US
Telephone Number	:	800-480-5243
Fax Number	:	800-928-7449

Provider Business Practice Location Address
First Line	:	2301 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-4615
Country	:	US
Telephone Number	:	239-574-8880
Fax Number	:	239-574-4876

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	07/13/2023

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Directions to “ LUZ E PEGUERO M.D.” Practice Location

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