1730183187 NPI number — EDGARD L PEREIRA M.D.

Table of content: EDGARD L PEREIRA M.D. (NPI 1730183187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730183187 NPI number — EDGARD L PEREIRA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREIRA
Provider First Name:
EDGARD
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730183187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17387 BALARIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33496-3279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-312-0057
Provider Business Mailing Address Fax Number:
954-239-3902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17387 BALARIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33496-3279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-312-0057
Provider Business Practice Location Address Fax Number:
954-239-3902
Provider Enumeration Date:
06/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  36956 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: ME104596 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2806906000 . This is a "PAD FOR NORTON" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50013581 . This is a "PASSPORT FOR NORTON" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 146SM . This is a "BCBSFL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 64049190 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00439749 . This is a "RRMCR FOR NORTON" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000507978 . This is a "ANTHEM FOR NORTON" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 146SM . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 200376030 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CS337Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 006516700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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