MEDICARE: PELAEZ AND MONTANE PA

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	208000000X	Pediatrics Physician	ME39365	FL
2	208000000X	Pediatrics Physician	ME71781	FL
3	208000000X	Pediatrics Physician	ME58346	FL
4	208000000X	Pediatrics Physician	ME52110	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1821025073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELAEZ AND MONTANE PA

Provider Business Mailing Address
First Line	:	1383 PROVIDENCE RD
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-4885
Country	:	US
Telephone Number	:	813-681-5714
Fax Number	:	813-689-9557

Provider Business Practice Location Address
First Line	:	1383 PROVIDENCE RD
Second Line	:	SUITE 102
City	:	BRANDON
State	:	FL
Zip	:	33511-4885
Country	:	US
Telephone Number	:	813-681-5714
Fax Number	:	813-689-9557

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. ROBERT N PELAEZ
Credential	:	MD
Telephone Number	:	813-681-5714

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	11/18/2011

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Directions to “PELAEZ AND MONTANE PA ” Practice Location

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