Provider Demographics
NPI:1972687929
Name:PANZNER, JOSEPH LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LAWRENCE
Last Name:PANZNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:330-666-4158
Mailing Address - Fax:330-668-2256
Practice Address - Street 1:3632 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3124
Practice Address - Country:US
Practice Address - Phone:330-666-4158
Practice Address - Fax:330-668-2256
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.040862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0344630Medicaid