Provider Demographics
NPI:1215474762
Name:PANTEL, JAMES RICHARD (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:PANTEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:RICHARD
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:702 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:ND
Mailing Address - Zip Code:58730-3329
Mailing Address - Country:US
Mailing Address - Phone:701-965-6349
Mailing Address - Fax:701-965-6301
Practice Address - Street 1:702 1ST ST SW
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:ND
Practice Address - Zip Code:58730-3329
Practice Address - Country:US
Practice Address - Phone:701-965-6349
Practice Address - Fax:701-965-6301
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0674207P00000X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1470612Medicaid