Provider Demographics
NPI:1811972235
Name:PANCORBO, DARIO (MD)
Entity type:Individual
Prefix:DR
First Name:DARIO
Middle Name:
Last Name:PANCORBO
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 1:8000 SW 117 AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4809
Mailing Address - Country:US
Mailing Address - Phone:305-279-0152
Mailing Address - Fax:305-279-2602
Practice Address - Street 1:8000 SW 117 AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4809
Practice Address - Country:US
Practice Address - Phone:305-279-0152
Practice Address - Fax:305-279-2602
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8285Medicare ID - Type Unspecified
FLI16328Medicare UPIN
FL43307BMedicare ID - Type Unspecified
FL43307AMedicare ID - Type Unspecified