Basic Information
| Provider Information | |||||||||
| NPI: | 1053364547 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN H PELOZA MD PA | ||||||||
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| OtherOrganizationName: | CENTER FOR SPINE CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17980 DALLAS PKWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143787200 | ||||||||
| FaxNumber: | 2143787205 | ||||||||
| Practice Location | |||||||||
| Address1: | 17980 DALLAS PKWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143787200 | ||||||||
| FaxNumber: | 2143787205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 11/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | PELOZA | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | ORTHOPEDIC SPINE SURGEON | ||||||||
| AuthorizedOfficialTelephone: | 2143787200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | G7094 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
No ID Information.