Provider Demographics
NPI:1508944877
Name:LUIS R PADRON MD PA
Entity Type:Organization
Organization Name:LUIS R PADRON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:PADRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-251-3991
Mailing Address - Street 1:9580 SW 107TH AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2792
Mailing Address - Country:US
Mailing Address - Phone:305-596-4440
Mailing Address - Fax:305-596-7618
Practice Address - Street 1:9580 SW 107TH AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2792
Practice Address - Country:US
Practice Address - Phone:305-596-4440
Practice Address - Fax:305-596-7618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6055Medicare ID - Type Unspecified