Provider Demographics
NPI:1831170240
Name:TIRADO, PEDRO W (MD)
Entity type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:W
Last Name:TIRADO
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2320 S SEACREST BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6517
Mailing Address - Country:US
Mailing Address - Phone:561-374-9932
Mailing Address - Fax:561-374-9946
Practice Address - Street 1:2320 S SEACREST BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6517
Practice Address - Country:US
Practice Address - Phone:561-374-9932
Practice Address - Fax:561-374-9946
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2014-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 00844282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271594500Medicaid
H64843Medicare UPIN
FL271594500Medicaid