Provider Demographics
NPI:1730183187
Name:PEREIRA, EDGARD L (MD)
Entity type:Individual
Prefix:
First Name:EDGARD
Middle Name:L
Last Name:PEREIRA
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 1:17387 BALARIA ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3279
Mailing Address - Country:US
Mailing Address - Phone:561-312-0057
Mailing Address - Fax:954-239-3902
Practice Address - Street 1:17387 BALARIA ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-3279
Practice Address - Country:US
Practice Address - Phone:561-312-0057
Practice Address - Fax:954-239-3902
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1045962085R0204X
KY369562085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000507978OtherANTHEM FOR NORTON
KYP00439749OtherRRMCR FOR NORTON
FLCS337ZOtherMEDICARE PTAN
FL146SMOtherBCBS
IN200376030Medicaid
KY50013581OtherPASSPORT FOR NORTON
KY64049190Medicaid
FL146SMOtherBCBSFL
KY2806906000OtherPAD FOR NORTON
KY0998828Medicare PIN
KY2806906000OtherPAD FOR NORTON
KYH33553Medicare UPIN
KY0276160Medicare ID - Type Unspecified