Provider Demographics
NPI:1235197781
Name:PINTO, SIMMY JERRY (MD)
Entity Type:Individual
Prefix:
First Name:SIMMY
Middle Name:JERRY
Last Name:PINTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:S. JERRY
Other - Middle Name:
Other - Last Name:PINTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:402 N BABCOCK ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-7335
Mailing Address - Country:US
Mailing Address - Phone:321-241-6540
Mailing Address - Fax:321-345-4815
Practice Address - Street 1:402 N BABCOCK ST
Practice Address - Street 2:SUITE 402
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7335
Practice Address - Country:US
Practice Address - Phone:321-327-2440
Practice Address - Fax:321-345-4815
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77004207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255692800Medicaid
FL44615TMedicare PIN
FL255692800Medicaid