Provider Demographics
NPI:1992094874
Name:KAREN PANTAZIS MD
Entity type:Organization
Organization Name:KAREN PANTAZIS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:PANTAZIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-354-1343
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:817 COURT ST
Practice Address - Street 2:SUITE 14
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2156
Practice Address - Country:US
Practice Address - Phone:916-354-1343
Practice Address - Fax:916-354-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42898208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty