Basic Information
| Provider Information | |||||||||
| NPI: | 1760680466 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREIRA | ||||||||
| FirstName: | MARIO | ||||||||
| MiddleName: | BERNARDO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8251 W BROWARD BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333242703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542557310 | ||||||||
| FaxNumber: | 9542557311 | ||||||||
| Practice Location | |||||||||
| Address1: | 8251 W BROWARD BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333242703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542557310 | ||||||||
| FaxNumber: | 9542557311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2007 | ||||||||
| LastUpdateDate: | 10/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA08487200 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME104716 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.