Provider Demographics
NPI:1669828794
Name:PANAS, KENTON BRANDT (MD)
Entity type:Individual
Prefix:DR
First Name:KENTON
Middle Name:BRANDT
Last Name:PANAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7544 JACQUE RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7162
Mailing Address - Country:US
Mailing Address - Phone:727-697-2200
Mailing Address - Fax:727-863-8774
Practice Address - Street 1:7544 JACQUE RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7162
Practice Address - Country:US
Practice Address - Phone:727-697-2200
Practice Address - Fax:727-863-8774
Is Sole Proprietor?:No
Enumeration Date:2016-05-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32409207X00000X
FLME158033207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery