Provider Demographics
NPI:1194822353
Name:PANDO, JARY (MD)
Entity type:Individual
Prefix:
First Name:JARY
Middle Name:
Last Name:PANDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8660 W FLAGLER ST
Mailing Address - Street 2:SUITE #200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2031
Mailing Address - Country:US
Mailing Address - Phone:305-227-5176
Mailing Address - Fax:305-554-4828
Practice Address - Street 1:13001 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1708
Practice Address - Country:US
Practice Address - Phone:305-227-5176
Practice Address - Fax:305-554-4828
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94774207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
68030OtherBCBS FL
I66369Medicare UPIN
68030OtherBCBS FL