Healthcare Provider Details

I. General information

NPI: 1184750358
Provider Name (Legal Business Name): PETER ANTHONY PANTERA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 E BASELINE RD STE 126
MESA AZ
85209-5006
US

IV. Provider business mailing address

7227 E BASELINE RD STE 126
MESA AZ
85209-5006
US

V. Phone/Fax

Practice location:
  • Phone: 480-868-9565
  • Fax: 480-834-3606
Mailing address:
  • Phone: 480-868-9565
  • Fax: 480-834-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPOD-001157
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: