Healthcare Provider Details

I. General information

NPI: 1881623122
Provider Name (Legal Business Name): ANTHONY NICHOLAS PANNOZZO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16244 MILITARY TRL #740
DELRAY BEACH FL
33484-6534
US

IV. Provider business mailing address

16244 MILITARY TRL #740
DELRAY BEACH FL
33484-6534
US

V. Phone/Fax

Practice location:
  • Phone: 561-381-5800
  • Fax: 561-381-5003
Mailing address:
  • Phone: 561-381-5800
  • Fax: 561-381-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME87910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: