Basic Information
| Provider Information | |||||||||
| NPI: | 1245347004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PELLA | ||||||||
| FirstName: | PABLO | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8773 PERIMETER PARK CT | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322161165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044933390 | ||||||||
| FaxNumber: | 9044933395 | ||||||||
| Practice Location | |||||||||
| Address1: | 6817 SOUTHPOINT PKWY | ||||||||
| Address2: | SUITE 801 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322166282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046463420 | ||||||||
| FaxNumber: | 9046463017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 09/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | ME64398 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | K2410 | 01 | FL | MEDICARE - GROUP | OTHER | 219953 | 01 | FL | AVMED | OTHER | 0111508-00 | 01 | FL | MEDICAID - GROUP | OTHER | 250465100 | 05 | FL | MEDICAID | 74509 | 01 | FL | FLORIDA BLUE - GROUP | OTHER | 25066 | 01 | FL | WELLCARE | OTHER |