Provider Demographics
NPI:1184631970
Name:DORADO, PACIFICO (MD)
Entity Type:Individual
Prefix:
First Name:PACIFICO
Middle Name:
Last Name:DORADO
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 1:2213 SOUTH 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638
Mailing Address - Country:US
Mailing Address - Phone:740-532-6634
Mailing Address - Fax:
Practice Address - Street 1:2213 SOUTH 9TH STREET
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638
Practice Address - Country:US
Practice Address - Phone:740-532-6634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35034105208600000X
KY20404208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0216500Medicaid
KY64734940Medicaid
OHP00776579OtherRR MEDICARE
KYP00677401OtherRRMC
KY000000589557OtherANTHEM BCBS
A74367Medicare UPIN
OHP00776579OtherRR MEDICARE
KYP00677401OtherRRMC
OH0216500Medicaid
KY64734940Medicaid