Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | ME0075883 | FL |
NPI | 1023091089 |
---|---|
Provider Name | Dr. Jorge M Pelaez |
First Address | Pensacola, FL 32514 |
Second Address | Pensacola, FL 32514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 15/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G76237 | (02) |