Provider Demographics
NPI:1932858693
Name:PANVINI, ALEXANDER SAMUEL (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:SAMUEL
Last Name:PANVINI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 ISERNIA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-2319
Mailing Address - Country:US
Mailing Address - Phone:086-560-1234
Mailing Address - Fax:
Practice Address - Street 1:4505 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89154-9900
Practice Address - Country:US
Practice Address - Phone:702-895-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program