Provider Demographics
NPI:1376583294
Name:PARDO, MANUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:A
Last Name:PARDO
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 1:42 BARKLEY CIR
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:42 BARKLEY CIR
Practice Address - Street 2:SUITE, 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4543
Practice Address - Country:US
Practice Address - Phone:239-728-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49556207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0420662-00Medicaid
FL0420662-00Medicaid
FLE22482Medicare UPIN