Provider Demographics
NPI:1619455789
Name:STEVEN D PEDRO MD PA
Entity Type:Organization
Organization Name:STEVEN D PEDRO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-336-0661
Mailing Address - Street 1:7833 OAKMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4231
Mailing Address - Country:US
Mailing Address - Phone:817-336-0661
Mailing Address - Fax:817-338-0744
Practice Address - Street 1:7833 OAKMONT BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4231
Practice Address - Country:US
Practice Address - Phone:817-336-0661
Practice Address - Fax:817-338-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7240207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty