Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 8911101-1205 | UT |
N | 208600000X | Surgeon | 8911101-1205 | UT |
N | 2086S0122X | Plastic and Reconstructive Surgery | 8911101-1205 | UT |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD60974739 | WA |
NPI | 1083737738 |
---|---|
Provider Name | Christopher John Pannucci |
First Address | Liberty Lake, WA 99019-0421 |
Second Address | Spokane, WA 99204-2456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 14/09/2021 |