Provider Demographics
NPI:1780686162
Name:PEDREGAL, ARTHUR J (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:J
Last Name:PEDREGAL
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 1:4710 N HABANA AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7161
Mailing Address - Country:US
Mailing Address - Phone:813-879-7940
Mailing Address - Fax:813-878-0670
Practice Address - Street 1:4710 N HABANA AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7161
Practice Address - Country:US
Practice Address - Phone:813-879-7940
Practice Address - Fax:813-878-0670
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73301174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593670555OtherEIN
FLG70618Medicare UPIN
FLE0746AMedicare ID - Type UnspecifiedMEDICARE ID