Provider Demographics
NPI:1134252463
Name:PELAEZ, ROBERT NEIL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:NEIL
Last Name:PELAEZ
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 1:3207 W CHAPIN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-2703
Mailing Address - Country:US
Mailing Address - Phone:813-786-7124
Mailing Address - Fax:
Practice Address - Street 1:901 E BLOOMINGDALE AVE STE 501
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8118
Practice Address - Country:US
Practice Address - Phone:813-699-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME393652080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE16904Medicare UPIN