Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 0101236977 | VA |
NPI | 1003887449 |
---|---|
Provider Name | Jean M Panneton |
First Address | Virginia Beach, VA 23452-5765 |
Second Address | Virginia Beach, VA 23452-5765 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 13/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F79660 | (02) | |
P00131086 | MEDICARE RAILROAD (01) |