Provider Demographics
NPI:1982671392
Name:PANGANIBAN, RUDOLFO A (MD)
Entity Type:Individual
Prefix:
First Name:RUDOLFO
Middle Name:A
Last Name:PANGANIBAN
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 1:5413 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4101
Mailing Address - Country:US
Mailing Address - Phone:727-846-7618
Mailing Address - Fax:727-849-7090
Practice Address - Street 1:5413 GEORGE ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4101
Practice Address - Country:US
Practice Address - Phone:727-846-7618
Practice Address - Fax:727-849-7090
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00825282081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263312400Medicaid
FLH43360Medicare UPIN
FL51307AMedicare ID - Type Unspecified