Provider Demographics
NPI:1295817948
Name:JASWANT SINGH PANNU MD PA
Entity Type:Organization
Organization Name:JASWANT SINGH PANNU MD PA
Other - Org Name:PANNU LASER INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANNU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-484-0700
Mailing Address - Street 1:4300 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1918
Mailing Address - Country:US
Mailing Address - Phone:954-484-0700
Mailing Address - Fax:954-484-0705
Practice Address - Street 1:4300 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1918
Practice Address - Country:US
Practice Address - Phone:954-484-0700
Practice Address - Fax:954-484-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty