Neurodx LLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

NEURODX LLC

Practice address

4714 N Armenia Ave
Suite 202
Tampa, FL 33603-2603

Phone

(813) 443-6957

Fax

(813) 443-4891

NPI assigned

Apr 28, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Edwin Nelson Peguero, M.D.

Title

Physician

Phone

(813) 443-6957

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461801600000",
    "number": "1104271014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4714 N ARMENIA AVE",
            "address_2": "SUITE 202",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336032603",
            "telephone_number": "813-443-6957",
            "fax_number": "813-443-4891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4714 N ARMENIA AVE",
            "address_2": "SUITE 202",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336032603",
            "telephone_number": "813-443-6957",
            "fax_number": "813-443-4891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEURODX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-28",
        "last_updated": "2016-04-28",
        "status": "A",
        "authorized_official_last_name": "PEGUERO",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_middle_name": "NELSON",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "813-443-6957",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neurology Physician in Tampa, FL
• Providers in Tampa, FL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.