Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 31052 | AZ |
N | 2081P2900X | Pain Medicine | 31052 | AZ |
N | 2081S0010X | Sports Medicine | 31052 | AZ |
N | 213ES0000X | Sports Medicine | 31052 | AZ |
NPI | 1497792097 |
---|---|
Provider Name | Dr. Paul Anthony Pannozzo |
First Address | Peoria, AZ 85382-3016 |
Second Address | Peoria, AZ 85382-3016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 07/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
858475 | (05) | AZ |
H71802 | (02) |