Provider Demographics
NPI:1700977709
Name:PINNAR, ERIC DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DAVID
Last Name:PINNAR
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 1:133 OSPREY COVE LN
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-6213
Mailing Address - Country:US
Mailing Address - Phone:904-808-5658
Mailing Address - Fax:878-847-2046
Practice Address - Street 1:4253 SALISBURY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6121
Practice Address - Country:US
Practice Address - Phone:904-808-5658
Practice Address - Fax:878-847-2046
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-059299208600000X
FLME108297208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006790400Medicaid
1700977709OtherNPI
VAG95574Medicare UPIN
VA003354P08Medicare ID - Type Unspecified