Provider Demographics
NPI:1215969605
Name:PARDO, GABRIEL (MD)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:PARDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 NE 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4602
Mailing Address - Country:US
Mailing Address - Phone:405-271-6242
Mailing Address - Fax:405-271-2887
Practice Address - Street 1:820 NE 15TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4602
Practice Address - Country:US
Practice Address - Phone:405-271-6242
Practice Address - Fax:405-271-2887
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205702084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100827890AMedicaid
OKOK700868Medicare UPIN
OK100827890AMedicaid
H11513Medicare UPIN
OKP00199417OtherRAILROAD
OK248432005Medicare PIN