MEDICARE: PEDRO T OLIVEROS JR 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
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1578784617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDRO T OLIVEROS JR MD PA

Provider Business Mailing Address
First Line	:	341 N MAITLAND AVE
Second Line	:	SUITE 200
City	:	MAITLAND
State	:	FL
Zip	:	32751-4783
Country	:	US
Telephone Number	:	407-265-2100
Fax Number	:	407-265-2872

Provider Business Practice Location Address
First Line	:	341 N MAITLAND AVE
Second Line	:	SUITE 200
City	:	MAITLAND
State	:	FL
Zip	:	32751-4783
Country	:	US
Telephone Number	:	407-265-2100
Fax Number	:	407-265-2872

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PEDRO T. OLIVEROS JR.
Credential	:	M.D.
Telephone Number	:	407-265-2100

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	11/04/2009

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