Provider Demographics
NPI:1457461725
Name:PANTERA, RICHARD LEO (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEO
Last Name:PANTERA
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 1:5344 W PROSPECT CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-9274
Mailing Address - Country:US
Mailing Address - Phone:559-625-1691
Mailing Address - Fax:559-625-1064
Practice Address - Street 1:202 W WILLOW AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6238
Practice Address - Country:US
Practice Address - Phone:559-732-5290
Practice Address - Fax:559-732-5674
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG364662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G364660Medicare PIN