Provider Demographics
NPI:1174622393
Name:PARDUE, CLEVELAND HENDRICK III (MD)
Entity type:Individual
Prefix:MR
First Name:CLEVELAND
Middle Name:HENDRICK
Last Name:PARDUE
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:455 SAINT MICHAELS DR
Mailing Address - Street 2:PHYSICIAN PRACTICES/CENTRAL BILLING OFFICE
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7601
Mailing Address - Country:US
Mailing Address - Phone:505-820-5227
Mailing Address - Fax:505-820-5645
Practice Address - Street 1:465 ST MICHAELS DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-984-0303
Practice Address - Fax:505-984-1116
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-10-24
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Provider Licenses
StateLicense IDTaxonomies
NM82101207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM20404Medicaid
NM20404Medicaid
D43257Medicare UPIN