Provider Demographics
NPI:1639297328
Name:PARDO, REYNALDO (MD)
Entity Type:Individual
Prefix:
First Name:REYNALDO
Middle Name:
Last Name:PARDO
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 1:12078 SAN JOSE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8671
Mailing Address - Country:US
Mailing Address - Phone:904-647-9199
Mailing Address - Fax:904-647-9198
Practice Address - Street 1:12078 SAN JOSE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8671
Practice Address - Country:US
Practice Address - Phone:904-647-9199
Practice Address - Fax:904-647-9198
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2019-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103267207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00200007388OtherUNITED HEALTHCARE
FL3193466OtherCIGNA
FL3193466OtherGWH
FL272694309OtherWORKERS COMPENSATION
FL272694309OtherBEECHSTREET
FL342136OtherAVMED
FL272694309OtherPIP
FL149UWOtherBCBS
FL272694309OtherMULTIPLAN
FLDR773ZMedicare PIN
FL272694309OtherMULTIPLAN
E90487Medicare UPIN