Provider Demographics
NPI:1295199891
Name:PARDO, BRYAN WILLIAM
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:WILLIAM
Last Name:PARDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 MASSACHUSETTS AVE
Mailing Address - Street 2:APT. 4
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 NW 9TH AVE
Practice Address - Street 2:STE. 470
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1101
Practice Address - Country:US
Practice Address - Phone:305-243-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-09
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine