Provider Demographics
NPI:1174586465
Name:PARDO, DAVERT (MD)
Entity type:Individual
Prefix:
First Name:DAVERT
Middle Name:
Last Name:PARDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15681 SW 8TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2409
Mailing Address - Country:US
Mailing Address - Phone:305-554-1656
Mailing Address - Fax:305-554-1656
Practice Address - Street 1:160 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4228
Practice Address - Country:US
Practice Address - Phone:786-243-8605
Practice Address - Fax:786-243-8013
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME89900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI16186Medicare UPIN