Provider Demographics
NPI:1760469654
Name:PEGUERO, LUZ E (MD)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:E
Last Name:PEGUERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:2301 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-4615
Practice Address - Country:US
Practice Address - Phone:239-574-8880
Practice Address - Fax:239-574-4876
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217674207R00000X
FLME107520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53099AOtherMEDICARE PIN
NY331833OtherMEDICARE OSCAR
NY02995513Medicaid
NY02251105Medicaid
NY02995513Medicaid
FL149FDOtherBCBS