Provider Demographics
NPI:1548371727
Name:PEJIC, BRANKO DUSAN (MD)
Entity type:Individual
Prefix:
First Name:BRANKO
Middle Name:DUSAN
Last Name:PEJIC
Suffix:
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 1:6305 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-8211
Mailing Address - Country:US
Mailing Address - Phone:321-638-4199
Mailing Address - Fax:321-631-7572
Practice Address - Street 1:6305 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-8211
Practice Address - Country:US
Practice Address - Phone:321-638-4199
Practice Address - Fax:321-631-7572
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G83710Medicare UPIN
35249Medicare ID - Type Unspecified