Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | ME0062002 | FL |
NPI | 1831123082 |
---|---|
Provider Name | Bradley S Panton |
First Address | Palm City, FL 34990-2610 |
Second Address | Palm City, FL 34990-2610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14997 | BXBS FL (01) | FL |
37713340001 | (05) | FL |
F27366 | (02) | FL |