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General NPI Number Information
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NPI Number | 1831123082
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Entity Type | Individual
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Provider Name | BRADLEY S PANTON MD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 1811 S 25TH ST
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City | FORT PIERCE
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State | FL
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Zip | 34947-4756
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Country | US
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Telephone | 772-467-1960
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Fax | 772-467-1097
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Provider Business Mailing Address
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Address Line | 2451 SW RACQUET CLUB DR
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City | PALM CITY
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State | FL
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Zip | 34990-2610
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Country | US
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Telephone | 772-221-8546
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | ME0062002
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME0062002
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License Number State | FL
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