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General NPI Number Information
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NPI Number | 1992094874
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Entity Type | Organization
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Legal Business Name | KAREN PANTAZIS MD
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 817 COURT ST SUITE 14
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City | JACKSON
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State | CA
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Zip | 95642-2156
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Country | US
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Telephone | 916-354-1343
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Fax | 916-354-1299
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Provider Business Mailing Address
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Address Line | PO BOX 7096
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City | STOCKTON
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State | CA
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Zip | 95267-0096
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Country | US
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Telephone | 209-956-7725
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Fax | 209-956-7733
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Authorized Official
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Title or Position | OWNER
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Name | KAREN LOUISE PANTAZIS
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Credential | MD
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Telephone | 916-354-1343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | C42898
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License Number State | CA
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