Provider Demographics
NPI:1265893085
Name:PELOZA SURGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:PELOZA SURGICAL SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PELOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-378-7200
Mailing Address - Street 1:17980 DALLAS PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6702
Mailing Address - Country:US
Mailing Address - Phone:214-378-7200
Mailing Address - Fax:214-378-7200
Practice Address - Street 1:17980 DALLAS PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-6702
Practice Address - Country:US
Practice Address - Phone:214-378-7200
Practice Address - Fax:214-378-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01810363A00000X
TXG7094207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8113N0Medicare PIN