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NPI Code Detail

MEDICARE: ANTONIO PRADO MD PA

MEDICARE: ANTONIO PRADO MD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology PhysicianME64750FL
2332H00000XEyewear Supplier
3152W00000XOptometrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
299062OTHERFLBLUE CROSS BLUE SHIELD FL
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376675454
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANTONIO PRADO MD PA
Provider Business Mailing Address
First Line : 7522 N HIMES AVE
Second Line :
City : TAMPA
State : FL
Zip : 33614-3205
Country : US
Telephone Number : 813-931-0500
Fax Number :
Provider Business Practice Location Address
First Line : 7522 N HIMES AVE
Second Line :
City : TAMPA
State : FL
Zip : 33614-3205
Country : US
Telephone Number : 813-931-0500
Fax Number :
Authorized Official
Title or Position : PRESIDENT CEO
Name : ANTONIO PRADO
Credential : MD
Telephone Number : 813-931-0500
Provider Enumeration Date : 03/12/2007
Last Update Date : 06/03/2020

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Directions to “ANTONIO PRADO MD PA ” Practice Location

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