=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174586465
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVERT PARDO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 NW 13TH ST
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33030-4228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-243-8605
-----------------------------------------------------
Fax | 786-243-8013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15681 SW 8TH LN
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33194-2409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-554-1656
-----------------------------------------------------
Fax | 305-554-1656
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME89900
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------