Provider Demographics
NPI:1376783548
Name:PANTARIDIS, THEODORE ANASTASIOS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:ANASTASIOS
Last Name:PANTARIDIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12067 BASIN ST W
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-5754
Mailing Address - Country:US
Mailing Address - Phone:561-639-9580
Mailing Address - Fax:
Practice Address - Street 1:5818 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-3608
Practice Address - Country:US
Practice Address - Phone:561-429-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103667363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical