Provider Demographics
NPI:1730172479
Name:PELLEGRINO, FRANCIS B (MD)
Entity type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:B
Last Name:PELLEGRINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:18550 US HIGHWAY 441
Mailing Address - Street 2:STE A
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6751
Mailing Address - Country:US
Mailing Address - Phone:727-992-6658
Mailing Address - Fax:352-503-0663
Practice Address - Street 1:1745 E HWY 50
Practice Address - Street 2:SUITE C
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5037
Practice Address - Country:US
Practice Address - Phone:352-394-8060
Practice Address - Fax:352-708-6420
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2019-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME55766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
593516436OtherTRICARE
FL054022600Medicaid
09743OtherBCBS FLORIDA
P00390401OtherRR PALMETTO GBA
E72777Medicare UPIN
09743UMedicare PIN