Provider Demographics
NPI:1508966615
Name:OLIVEROS, PEDRO T JR (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:T
Last Name:OLIVEROS
Suffix:JR
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 1:341 N. MAITLAND AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4761
Mailing Address - Country:US
Mailing Address - Phone:407-265-2100
Mailing Address - Fax:407-265-2872
Practice Address - Street 1:341 N. MAITLAND AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4761
Practice Address - Country:US
Practice Address - Phone:407-265-2100
Practice Address - Fax:407-265-2872
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76859208100000X
FLME 768592081P2900X
FLPT4493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46621Medicare PIN
G74422Medicare UPIN