MEDICARE: ERIC O PANTALEON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME006389	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME0063889	OTHER	FL	STATE MEDICAL LICENSE
2	1518997964	OTHER	FL	NPI

General Provider Information

NPI Number	:	1518997964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC O PANTALEON M.D.

Provider Business Mailing Address
First Line	:	3107 W HALLANDALE BEACH BLVD STE 102
Second Line	:
City	:	HALLANDALE
State	:	FL
Zip	:	33009-5144
Country	:	US
Telephone Number	:	786-638-4747
Fax Number	:	954-367-3763

Provider Business Practice Location Address
First Line	:	3107 W HALLANDALE BEACH BLVD STE 102
Second Line	:
City	:	HALLANDALE
State	:	FL
Zip	:	33009-5144
Country	:	US
Telephone Number	:	786-638-4747
Fax Number	:	954-367-3763

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	06/22/2022

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