Healthcare Provider Details

I. General information

NPI: 1497792097
Provider Name (Legal Business Name): PAUL ANTHONY PANNOZZO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8877 W UNION HILLS DR STE 200
PEORIA AZ
85382-3016
US

IV. Provider business mailing address

13128 N 94TH DR STE 200
PEORIA AZ
85381-4253
US

V. Phone/Fax

Practice location:
  • Phone: 623-776-8686
  • Fax: 623-776-8687
Mailing address:
  • Phone: 602-840-0681
  • Fax: 602-957-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number31052
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number31052
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number31052
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number31052
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: