Provider Demographics
NPI:1750495966
Name:PARDO-RUIZ, FERNANDO JAVIER (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:JAVIER
Last Name:PARDO-RUIZ
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 1:122 S GOLD AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-3755
Mailing Address - Country:US
Mailing Address - Phone:505-544-7280
Mailing Address - Fax:505-544-7281
Practice Address - Street 1:122 S GOLD AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-3755
Practice Address - Country:US
Practice Address - Phone:505-544-7280
Practice Address - Fax:505-544-7281
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2005-0179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM009V80OtherBLUE CROSS BLUE SHIELD
A0008OtherTRICARE
NM40273261Medicaid
I37253Medicare UPIN
NM343523102Medicare PIN