Provider Demographics
NPI:1235817081
Name:PANNEFLEK, JATHNIEL JUDAH (MD)
Entity Type:Individual
Prefix:
First Name:JATHNIEL
Middle Name:JUDAH
Last Name:PANNEFLEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 MICHAELANGELO DR STE 301
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-1405
Mailing Address - Country:US
Mailing Address - Phone:195-663-8221
Mailing Address - Fax:
Practice Address - Street 1:2821 MICHAELANGELO DR STE 301
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1405
Practice Address - Country:US
Practice Address - Phone:195-663-8221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program