Provider Demographics
NPI:1376172684
Name:PANTER, ALEXANDER H
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:H
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 1:107 JADE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVALE
Mailing Address - State:TN
Mailing Address - Zip Code:37153-4055
Mailing Address - Country:US
Mailing Address - Phone:615-785-9129
Mailing Address - Fax:
Practice Address - Street 1:961 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3909
Practice Address - Country:US
Practice Address - Phone:615-785-9129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine