Provider Demographics
NPI:1609098110
Name:PINEDO, DARYL (MD)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:
Last Name:PINEDO
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 1:1600 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-1297
Mailing Address - Country:US
Mailing Address - Phone:660-885-5511
Mailing Address - Fax:
Practice Address - Street 1:1600 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-1297
Practice Address - Country:US
Practice Address - Phone:660-885-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD733462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01266895OtherRR MEDICARE
MD056119300Medicaid
MO1609098110Medicaid
MOP01266895OtherRR MEDICARE
MD056119300Medicaid