Provider Demographics
NPI:1831594514
Name:COOLEY GEORGE PANTAZIS, MD PA
Entity type:Organization
Organization Name:COOLEY GEORGE PANTAZIS, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COOLEY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:PANTAZIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-208-7514
Mailing Address - Street 1:PO BOX 743170
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3170
Mailing Address - Country:US
Mailing Address - Phone:352-622-1378
Mailing Address - Fax:352-622-3672
Practice Address - Street 1:1500 SW 1ST AVENUE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-351-7262
Practice Address - Fax:352-402-5047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800000163207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty