Provider Demographics
NPI:1386675767
Name:PELOTE, EDWARD W (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:W
Last Name:PELOTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 S 25TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4739
Mailing Address - Country:US
Mailing Address - Phone:772-465-9901
Mailing Address - Fax:772-465-9807
Practice Address - Street 1:1905 S 25TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4739
Practice Address - Country:US
Practice Address - Phone:772-465-9901
Practice Address - Fax:772-465-9807
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME93493207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB309Medicare PIN
A97799Medicare UPIN
FLU6768Medicare PIN
FLU6768ZMedicare ID - Type Unspecified