1639297328 NPI number — REYNALDO PARDO M.D.

Table of content: REYNALDO PARDO M.D. (NPI 1639297328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639297328 NPI number — REYNALDO PARDO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARDO
Provider First Name:
REYNALDO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639297328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12078 SAN JOSE BLVD STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32223-8671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-647-9199
Provider Business Mailing Address Fax Number:
904-647-9198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12078 SAN JOSE BLVD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32223-8671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-647-9199
Provider Business Practice Location Address Fax Number:
904-647-9198
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  ME103267 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00200007388 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3193466 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3193466 . This is a "GWH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 272694309 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 272694309 . This is a "BEECHSTREET" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 342136 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 272694309 . This is a "PIP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 149UW . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 272694309 . This is a "MULTIPLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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