Provider Demographics
NPI:1073629978
Name:PELED, DROR M (MD)
Entity Type:Individual
Prefix:DR
First Name:DROR
Middle Name:M
Last Name:PELED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 MILE STRETCH DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-4348
Mailing Address - Country:US
Mailing Address - Phone:727-944-2005
Mailing Address - Fax:727-944-4080
Practice Address - Street 1:5035 MILE STRETCH DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34690-4432
Practice Address - Country:US
Practice Address - Phone:727-944-2005
Practice Address - Fax:727-935-4879
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0077763173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256027500Medicaid
FL47009OtherBLUE CROSS BLUE SHIELD
FL256027500Medicaid