Provider Demographics
NPI:1083608509
Name:PADILLA, PEDRO C (MD PC)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:C
Last Name:PADILLA
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MANOR DR
Mailing Address - Street 2:PO BOX 267
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-2044
Mailing Address - Country:US
Mailing Address - Phone:636-528-6844
Mailing Address - Fax:636-462-2809
Practice Address - Street 1:20 MANOR DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-0267
Practice Address - Country:US
Practice Address - Phone:636-528-6844
Practice Address - Fax:636-462-2809
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35762208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BLC0071180001OtherBLUE CHOICE
826343353AOtherRAILROAD
BLC007118002OtherBLUE CHOICE
4397518OtherAETNA
4906THFROtherBLUE SHIELD KC
0000317OtherNHC BENEFIT
12731OtherGROUP HEALTH PLAN
412131784OtherCOMMERCIAL
7896OtherBLUE SHIELD
11548OtherESSENCE
12076745OtherMULTI-PLAN
MO201214509Medicaid
A90852OtherMERCY
101073OtherHEALTHLINK
25125OtherCARPENTERS
MO201214509Medicaid
826343353AOtherRAILROAD
11548OtherESSENCE