Individual
DR. THOMAS SCOTT PANNKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 MARTIN LUTHER KING AVE NE, ALBUQUERQUE, NM 87102-3619
(505) 727-8000
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
41606-020
WI
207P00000X
Emergency Medicine Physician
Primary
MD60793240
WA
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
9372-A
WY
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
MD2014-0522
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104160666
—
MI
05
—
31814700
—
WI
01
—
930078269
MEDICARE RAILROAD
WI
01
—
930079986
MEDICARE RAILROAD
WI
01
—
930106591
MEDICARE RAILROAD
WI
Enumeration date
07/10/2006
Last updated
08/15/2019
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