Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PO 2663 | FL |
NPI | 1184750358 |
---|---|
Provider Name | Dr. Peter Anthony Pantera |
First Address | Bonita Springs, FL 34134-2635 |
Second Address | Fort Myers, FL 33916-9413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2007 |
Last Update Date | 09/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U59390 | (02) | FL |