Provider Demographics
NPI:1154671022
Name:ARTHUR J. PEDREGAL MD PA
Entity Type:Organization
Organization Name:ARTHUR J. PEDREGAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PEDREGA;
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-879-7940
Mailing Address - Street 1:4710 N HABANA AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7151
Mailing Address - Country:US
Mailing Address - Phone:813-879-7940
Mailing Address - Fax:813-878-0670
Practice Address - Street 1:4710 N HABANA AVE STE 303
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7151
Practice Address - Country:US
Practice Address - Phone:813-879-7940
Practice Address - Fax:813-878-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG70618Medicare UPIN
FLE0746AMedicare PIN