Healthcare Provider Details

I. General information

NPI: 1770661423
Provider Name (Legal Business Name): KAREN LOUISE PANTAZIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN LOUISE ZUREK MD

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 COURT ST SUITE 14
JACKSON CA
95642-2156
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 209-357-0503
  • Fax: 209-257-1392
Mailing address:
  • Phone: 209-956-7725
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC42898
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberC42898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: