MEDICARE: DR. STEVEN DOUGLAS PEDRO 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	174400000X	Specialist	D7240	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	75-2627054	OTHER	TX	TAX ID

General Provider Information

NPI Number	:	1982634481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN DOUGLAS PEDRO M.D.

Provider Business Mailing Address
First Line	:	7833 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4204
Country	:	US
Telephone Number	:	817-336-0661
Fax Number	:	817-338-0744

Provider Business Practice Location Address
First Line	:	7833 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4204
Country	:	US
Telephone Number	:	817-336-0661
Fax Number	:	817-338-0744

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	11/18/2009

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