Provider Demographics
NPI:1407887128
Name:PANOS, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PANOS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1905 CLINT MOORE RD #212
Mailing Address - Street 2:JOHN PANOS MD
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496
Mailing Address - Country:US
Mailing Address - Phone:561-989-9040
Mailing Address - Fax:561-989-0255
Practice Address - Street 1:1905 CLINT MOORE RD #212
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496
Practice Address - Country:US
Practice Address - Phone:561-989-9070
Practice Address - Fax:561-989-0255
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL85030207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265762700Medicaid
FL265762700Medicaid
H65931Medicare UPIN