Provider Demographics
NPI:1770661423
Name:PANTAZIS, KAREN LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LOUISE
Last Name:PANTAZIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LOUISE
Other - Last Name:ZUREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:817 COURT ST
Practice Address - Street 2:SUITE 14
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2156
Practice Address - Country:US
Practice Address - Phone:209-357-0503
Practice Address - Fax:209-257-1392
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42898207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C428980Medicaid
CA00C428980Medicare PIN
CAP01109766Medicare PIN
B28431Medicare UPIN