Provider Demographics
NPI:1437144524
Name:MARDONES, OSVALDO F (MD)
Entity Type:Individual
Prefix:DR
First Name:OSVALDO
Middle Name:F
Last Name:MARDONES
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 1:315 75TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3201
Mailing Address - Country:US
Mailing Address - Phone:941-761-1998
Mailing Address - Fax:941-794-6199
Practice Address - Street 1:315 75TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3201
Practice Address - Country:US
Practice Address - Phone:941-792-2211
Practice Address - Fax:941-794-6199
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28270OtherBCBS
FL110169972OtherRAIL ROAD MEDICARE
FL379571300Medicaid
28270WMedicare PIN
FL28270YMedicare PIN
FL110169972OtherRAIL ROAD MEDICARE
FL28270OtherBCBS