Provider Demographics
NPI:1972697308
Name:PARDUE, KARIN J (MD)
Entity type:Individual
Prefix:MS
First Name:KARIN
Middle Name:J
Last Name:PARDUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:C
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:CENTURY
Mailing Address - State:FL
Mailing Address - Zip Code:32535-0399
Mailing Address - Country:US
Mailing Address - Phone:850-256-5314
Mailing Address - Fax:850-256-4433
Practice Address - Street 1:8401 N CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:CENTURY
Practice Address - State:FL
Practice Address - Zip Code:32535
Practice Address - Country:US
Practice Address - Phone:850-256-5314
Practice Address - Fax:850-256-4433
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24484207Q00000X
FLME119749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51518970PAROtherBC/BS
ALP00141834OtherMEDICARE RAILROAD
ALP00141834OtherMEDICARE RAILROAD
ALJ672Medicare PIN
AL200253396OtherEIN NUMBER
AL051518970Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER