Provider Demographics
NPI:1497835318
Name:PANTHER, DAVID E (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:PANTHER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84026
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-8426
Mailing Address - Country:US
Mailing Address - Phone:206-292-7990
Mailing Address - Fax:
Practice Address - Street 1:801 BROADWAY STE 808
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4328
Practice Address - Country:US
Practice Address - Phone:206-292-7990
Practice Address - Fax:206-292-4882
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001020207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8371825Medicaid
WAAB20559Medicare PIN
S 45662Medicare UPIN
WA8371825Medicaid