Provider Demographics
NPI:1861883712
Name:MANUEL A. PARDO, M.D.
Entity type:Organization
Organization Name:MANUEL A. PARDO, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-728-3500
Mailing Address - Street 1:42 BARKLEY CIR
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4543
Mailing Address - Country:US
Mailing Address - Phone:239-728-3500
Mailing Address - Fax:
Practice Address - Street 1:42 BARKLEY CIR
Practice Address - Street 2:SUITE # 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4543
Practice Address - Country:US
Practice Address - Phone:239-728-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0420662-00Medicaid
08428OtherBLUE CROSS/BLUE SHIELD
FL0420662-00Medicaid
08428Medicare PIN