MEDICARE: EDGARD L PEREIRA 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	2085R0204X	Vascular & Interventional Radiology Physician	ME104596	FL
2	2085R0204X	Vascular & Interventional Radiology Physician	36956	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CS337Z	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000507978	OTHER	KY	ANTHEM FOR NORTON
2	P00439749	OTHER	KY	RRMCR FOR NORTON
4	146SM	OTHER	FL	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	50013581	OTHER	KY	PASSPORT FOR NORTON
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	146SM	OTHER	FL	BCBSFL
9	2806906000	OTHER	KY	PAD FOR NORTON
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730183187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGARD L PEREIRA M.D.

Provider Business Mailing Address
First Line	:	17387 BALARIA ST
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-3279
Country	:	US
Telephone Number	:	561-312-0057
Fax Number	:	954-239-3902

Provider Business Practice Location Address
First Line	:	17387 BALARIA ST
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-3279
Country	:	US
Telephone Number	:	561-312-0057
Fax Number	:	954-239-3902

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	06/27/2024

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Directions to “ EDGARD L PEREIRA M.D.” Practice Location

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