Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | ME39365 | FL |
NPI | 1134252463 |
---|---|
Provider Name | Robert Neil Pelaez |
First Address | Brandon, FL 33511-4885 |
Second Address | Brandon, FL 33511-4885 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 21/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E16904 | (02) | FL |