Provider Demographics
NPI:1174626394
Name:ABREU, PEDRO J (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:J
Last Name:ABREU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3929
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463
Mailing Address - Country:US
Mailing Address - Phone:361-887-7708
Mailing Address - Fax:361-887-0740
Practice Address - Street 1:2601 HOSPITAL BLVD
Practice Address - Street 2:STE 114
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405
Practice Address - Country:US
Practice Address - Phone:361-887-7708
Practice Address - Fax:361-887-0740
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123263902Medicaid
TX00H31DMedicare ID - Type Unspecified
C12583Medicare UPIN