Provider Demographics
NPI:1982634481
Name:PEDRO, STEVEN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:PEDRO
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 1:7833 OAKMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4204
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:76132-4204
Practice Address - Country:US
Practice Address - Phone:817-336-0661
Practice Address - Fax:817-338-0744
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7240174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2627054OtherTAX ID
TXB25429Medicare UPIN
TX00AK13Medicare ID - Type Unspecified