Provider Demographics
NPI:1376123737
Name:PEJO, KRISTI (MD)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:PEJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTI
Other - Middle Name:
Other - Last Name:PEJO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:203 N MARION ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4914
Mailing Address - Country:US
Mailing Address - Phone:813-474-9804
Mailing Address - Fax:813-540-6025
Practice Address - Street 1:203 N MARION ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4914
Practice Address - Country:US
Practice Address - Phone:813-474-9804
Practice Address - Fax:813-540-6025
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
FLME169283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL124487600Medicaid