Healthcare Provider Details

I. General information

NPI: 1255428629
Provider Name (Legal Business Name): JAMES GORDON KANTOR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EAGLETON LN
PALM BEACH GARDENS FL
33418-8052
US

IV. Provider business mailing address

100 EAGLETON LN
PALM BEACH GARDENS FL
33418-8052
US

V. Phone/Fax

Practice location:
  • Phone: 267-679-1492
  • Fax:
Mailing address:
  • Phone: 267-679-1492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberOS003487L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: