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PACIFICO DORADO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2213 SOUTH 9TH STREET, IRONTON, OH 45638
(740) 532-6634
Mailing address
2213 SOUTH 9TH STREET, IRONTON, OH 45638
(740) 532-6634

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
20404
KY
208600000X
Surgery Physician
Primary
35034105
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000589557
ANTHEM BCBS
KY
05
0216500
OH
05
64734940
KY
01
P00677401
RRMC
KY
01
P00776579
RR MEDICARE
OH
Enumeration date
08/02/2006
Last updated
01/28/2010
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