MEDICARE: BRADLEY S PANTON MD

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	207RA0401X	Addiction Medicine (Internal Medicine) Physician	ME0062002	FL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME0062002	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14997	OTHER	FL	BXBS FL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831123082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY S PANTON MD

Provider Business Mailing Address
First Line	:	2451 SW RACQUET CLUB DR
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-2610
Country	:	US
Telephone Number	:	772-221-8546
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 S 25TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4756
Country	:	US
Telephone Number	:	772-467-1960
Fax Number	:	772-467-1097

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	02/12/2024

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