Provider Demographics
NPI:1689741704
Name:PASTORA, REINALDO F (MD)
Entity type:Individual
Prefix:
First Name:REINALDO
Middle Name:F
Last Name:PASTORA
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 1:421 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1227
Mailing Address - Country:US
Mailing Address - Phone:812-426-9483
Mailing Address - Fax:812-426-9880
Practice Address - Street 1:421 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1227
Practice Address - Country:US
Practice Address - Phone:812-426-9483
Practice Address - Fax:812-426-9880
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035194207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100203610Medicaid
IN000000584865OtherANTHEM
IN000000584865OtherANTHEM
IN258150BMedicare PIN
INP00646529Medicare PIN