Provider Demographics
NPI:1013288604
Name:PARDOLL, PETER MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:PARDOLL
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 1:34 PARADISE LANE
Mailing Address - Street 2:
Mailing Address - City:TREASURE ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33706
Mailing Address - Country:US
Mailing Address - Phone:727-422-5464
Mailing Address - Fax:727-360-5352
Practice Address - Street 1:34 PARADISE LN
Practice Address - Street 2:
Practice Address - City:TREASURE ISLAND
Practice Address - State:FL
Practice Address - Zip Code:33706-1129
Practice Address - Country:US
Practice Address - Phone:727-422-5464
Practice Address - Fax:727-360-5352
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24487207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology