Provider Demographics
NPI:1659454072
Name:PARDO, JOSE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:PARDO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VETERANS DR
Mailing Address - Street 2:VAMC (11P)
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:612-467-2473
Mailing Address - Fax:612-725-2249
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:VAMC (11P)
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-2473
Practice Address - Fax:612-725-2249
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR7G542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry