Provider Demographics
NPI:1285694455
Name:PANTHER, RANDY L (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:L
Last Name:PANTHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21710 EDEN ROSE HL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-1670
Mailing Address - Country:US
Mailing Address - Phone:800-927-1381
Mailing Address - Fax:800-927-1381
Practice Address - Street 1:21710 EDEN ROSE HL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-1670
Practice Address - Country:US
Practice Address - Phone:800-927-1381
Practice Address - Fax:800-927-1381
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM8899207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F21264Medicare PIN