Provider Demographics
NPI:1588758676
Name:RIOS, PASTOR H (MD)
Entity type:Individual
Prefix:DR
First Name:PASTOR
Middle Name:H
Last Name:RIOS
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 1:449 SE BAYA DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025
Mailing Address - Country:US
Mailing Address - Phone:386-755-0500
Mailing Address - Fax:386-755-9217
Practice Address - Street 1:449 SE BAYA DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025
Practice Address - Country:US
Practice Address - Phone:386-755-0500
Practice Address - Fax:386-755-9217
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45687174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07742OtherBCBS PROVIDER NUMBER
FL030461OtherAVMED PROVIDER NUMBER
FL030461OtherAVMED PROVIDER NUMBER
FL07742OtherBCBS PROVIDER NUMBER