Provider Demographics
NPI:1295792513
Name:PEGUES, HERBERT ULLMER II (MD)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:ULLMER
Last Name:PEGUES
Suffix:II
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 1:8437 TUTTLE AVE
Mailing Address - Street 2:362
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2868
Mailing Address - Country:US
Mailing Address - Phone:941-779-3553
Mailing Address - Fax:
Practice Address - Street 1:8451 SHADE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2878
Practice Address - Country:US
Practice Address - Phone:941-779-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF40926Medicare UPIN