Individual
MRS. MARYSE ANNE PEDOUSSAUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
800 SW 108TH AVE STE 100, MIAMI, FL 33174
(305) 348-3627
(305) 348-4261
Mailing address
800 SW 108TH AVENUE, SUITE 100, MIAMI LAKES, FL 33014-6540
(305) 348-3627
(305) 348-4261
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
ME 82118
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2633906
—
FL
Enumeration date
06/18/2006
Last updated
09/10/2018
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