Provider Demographics
NPI:1225446271
Name:PEGUERO MORENO, JULIO G (MD)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:G
Last Name:PEGUERO MORENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JULIO
Other - Middle Name:GABRIEL
Other - Last Name:PEGUERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:1951 SW 172ND AVE STE 404
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5614
Practice Address - Country:US
Practice Address - Phone:954-265-7900
Practice Address - Fax:954-893-6385
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 125573207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018263300Medicaid