Provider Demographics
NPI:1427069590
Name:PELAEZ FREIDEL, ANDRES (MD)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:PELAEZ FREIDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANDRES
Other - Middle Name:
Other - Last Name:PELAEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1600 SW ARCHER RD
Mailing Address - Street 2:#100371
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-3001
Mailing Address - Country:US
Mailing Address - Phone:352-265-0301
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-243-6388
Practice Address - Fax:305-243-6372
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107563207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME107563OtherMEDICAL LISENCE
FL002647400Medicaid
FLEQ023VMedicare PIN