Provider Demographics
NPI:1912194283
Name:PELAYO, MIGUEL R (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:R
Last Name:PELAYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:5985 SILVER FALLS RUN
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-1290
Practice Address - Country:US
Practice Address - Phone:941-907-4737
Practice Address - Fax:941-907-9493
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2022-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME100373207RX0202X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000424500Medicaid
FLBJ019YMedicare PIN