Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | ME24487 | FL |
NPI | 1013288604 |
---|---|
Provider Name | Dr. Peter Michael Pardoll |
First Address | Treasure Island, FL 33706 |
Second Address | Treasure Island, FL 33706-1129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2012 |
Last Update Date | 13/01/2012 |