Healthcare Provider Details

I. General information

NPI: 1730111535
Provider Name (Legal Business Name): PEDRO VIEIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 DEL PRADO BLVD N STE 201
CAPE CORAL FL
33909-2278
US

IV. Provider business mailing address

632 DEL PRADO BLVD N STE 201
CAPE CORAL FL
33909-2278
US

V. Phone/Fax

Practice location:
  • Phone: 239-829-7102
  • Fax:
Mailing address:
  • Phone: 239-829-7102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number25MA07986600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: