Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 0101056492 | VA |
NPI | 1013911742 |
---|---|
Provider Name | Robert Richard Panten JR. |
First Address | Richmond, VA 23235-4724 |
Second Address | Richmond, VA 23235-4724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 06/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H23973 | (02) | VA |