Healthcare Provider Details

I. General information

NPI: 1932163896
Provider Name (Legal Business Name): THOMAS ANGELO PANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 MILITARY TRL SUITE #210
JUPITER FL
33458-5700
US

IV. Provider business mailing address

224 LONE PINE DR
PALM BEACH GARDENS FL
33410-2467
US

V. Phone/Fax

Practice location:
  • Phone: 561-747-8100
  • Fax: 561-746-0495
Mailing address:
  • Phone: 561-775-7819
  • Fax: 561-775-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME 94792
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: