Provider Demographics
NPI:1457148892
Name:GORE PANTER, SHAMONE R (DO, PHD)
Entity type:Individual
Prefix:
First Name:SHAMONE
Middle Name:R
Last Name:GORE PANTER
Suffix:
Gender:
Credentials:DO, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1460
Mailing Address - Country:US
Mailing Address - Phone:330-881-8045
Mailing Address - Fax:
Practice Address - Street 1:14601 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4205
Practice Address - Country:US
Practice Address - Phone:216-237-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.035122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine