Provider Demographics
NPI:1073822102
Name:PANTER, MATTHEW EDWARD
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:EDWARD
Last Name:PANTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 APRIL LANE
Mailing Address - Street 2:
Mailing Address - City:CHINA SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:76633-0523
Mailing Address - Country:US
Mailing Address - Phone:254-752-4397
Mailing Address - Fax:254-848-9019
Practice Address - Street 1:414 APRIL LN
Practice Address - Street 2:
Practice Address - City:CHINA SPRING
Practice Address - State:TX
Practice Address - Zip Code:76633-2923
Practice Address - Country:US
Practice Address - Phone:254-752-4397
Practice Address - Fax:254-848-9019
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications