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: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 LAKE UNDERHILL RD STE 215
ORLANDO FL
32828-4511
US

IV. Provider business mailing address

12301 LAKE UNDERHILL RD STE 215
ORLANDO FL
32828-4511
US

V. Phone/Fax

Practice location:
  • Phone: 321-235-0692
  • Fax: 212-350-6943
Mailing address:
  • Phone: 321-235-0692
  • Fax: 212-350-6943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO 2663
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: