Provider Demographics
NPI:1750470548
Name:PESTANA, JOSE MIGUEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MIGUEL
Last Name:PESTANA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4168 WOODLANDS PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3496
Mailing Address - Country:US
Mailing Address - Phone:727-781-7711
Mailing Address - Fax:727-781-8711
Practice Address - Street 1:4168 WOODLANDS PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3496
Practice Address - Country:US
Practice Address - Phone:727-781-7711
Practice Address - Fax:727-781-8711
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS9855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05685OtherBCBS
FL279033500Medicaid
FL279033500Medicaid
FLAE805VMedicare PIN
FLAE805ZMedicare Oscar/Certification