Provider Demographics
NPI:1538123393
Name:PANOS, ANTHONY L (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:L
Last Name:PANOS
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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-4155
Mailing Address - Fax:319-356-3891
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-356-4155
Practice Address - Fax:319-356-3891
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-46214208600000X, 208G00000X
FLME87663208G00000X
MS24194208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03574842Medicaid
FL2670780-00Medicaid
FL79421Medicare UPIN
FLF69471Medicare UPIN
MS468602YJ5DMedicare PIN
FL2670780-00Medicaid