Provider Demographics
NPI:1518997964
Name:PANTALEON, ERIC O (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:O
Last Name:PANTALEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:O
Other - Last Name:PANTALEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3107 W HALLANDALE BEACH BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5144
Mailing Address - Country:US
Mailing Address - Phone:786-638-4747
Mailing Address - Fax:954-367-3763
Practice Address - Street 1:3107 W HALLANDALE BEACH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009-5144
Practice Address - Country:US
Practice Address - Phone:786-638-4747
Practice Address - Fax:954-367-3763
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME006389174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0063889OtherSTATE MEDICAL LICENSE
FL1518997964OtherNPI
FLE62979Medicare UPIN