Healthcare Provider Details

I. General information

NPI: 1164415667
Provider Name (Legal Business Name): PETE PAPAPANOS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 S KANNER HWY
STUART FL
34994
US

IV. Provider business mailing address

1815 S KANNER HWY
STUART FL
34994
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-2992
  • Fax: 772-288-2999
Mailing address:
  • Phone: 772-288-2992
  • Fax: 772-288-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301070188
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: