Provider Demographics
NPI:1568485852
Name:PECORARO, ALPHONSE M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALPHONSE
Middle Name:M
Last Name:PECORARO
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 1:1133 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2836
Mailing Address - Country:US
Mailing Address - Phone:321-637-2975
Mailing Address - Fax:321-433-1935
Practice Address - Street 1:1133 SEMINOLE DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2836
Practice Address - Country:US
Practice Address - Phone:321-637-2975
Practice Address - Fax:321-433-1935
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85276208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264438000Medicaid
FL264438000Medicaid
FL13984ZMedicare PIN