Provider Demographics
NPI:1376646240
Name:PARDO, FORSTOT, BACA, ALBOUKREK, P.A.
Entity Type:Organization
Organization Name:PARDO, FORSTOT, BACA, ALBOUKREK, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-368-2125
Mailing Address - Street 1:1050 NW 15TH ST
Mailing Address - Street 2:SUITE 208A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1375
Mailing Address - Country:US
Mailing Address - Phone:561-498-1114
Mailing Address - Fax:561-498-8338
Practice Address - Street 1:5162 LINTON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6567
Practice Address - Country:US
Practice Address - Phone:561-498-1114
Practice Address - Fax:561-498-8338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39079CMedicare ID - Type Unspecified