MEDICARE: REYNALDO PARDO M.D.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME103267	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00200007388	OTHER	FL	UNITED HEALTHCARE
2	3193466	OTHER	FL	CIGNA
3	3193466	OTHER	FL	GWH
4	272694309	OTHER	FL	WORKERS COMPENSATION
5	272694309	OTHER	FL	BEECHSTREET
6	342136	OTHER	FL	AVMED
7	272694309	OTHER	FL	PIP
8	149UW	OTHER	FL	BCBS
9	272694309	OTHER	FL	MULTIPLAN

General Provider Information

NPI Number	:	1639297328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REYNALDO PARDO M.D.

Provider Business Mailing Address
First Line	:	12078 SAN JOSE BLVD STE 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8671
Country	:	US
Telephone Number	:	904-647-9199
Fax Number	:	904-647-9198

Provider Business Practice Location Address
First Line	:	12078 SAN JOSE BLVD STE 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8671
Country	:	US
Telephone Number	:	904-647-9199
Fax Number	:	904-647-9198

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	05/25/2019

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