Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | 01055503A | IN |
Y | 207RG0100X | Gastroenterologist | 065044 | GA |
NPI | 1023084449 |
---|---|
Provider Name | Dr. Matthew William Pantsari |
First Address | Evans, GA 30809-3096 |
Second Address | Tifton, GA 31794-3648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2006 |
Last Update Date | 04/10/2018 |