Provider Demographics
NPI:1861467698
Name:PELLOSIE, JOHN CARMEN JR (DO, MPH, FAOCOP)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARMEN
Last Name:PELLOSIE
Suffix:JR
Gender:M
Credentials:DO, MPH, FAOCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
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Mailing Address - Street 1:408 MAGNOLIA ENDING
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-9001
Mailing Address - Country:US
Mailing Address - Phone:352-385-2651
Mailing Address - Fax:
Practice Address - Street 1:16140 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6508
Practice Address - Country:US
Practice Address - Phone:352-589-6424
Practice Address - Fax:352-589-1325
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS 42462083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine