1093899981 NPI number — JOHN PAWLOSKI M.D., PH. D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093899981 NPI number — JOHN PAWLOSKI M.D., PH. D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PAWLOSKI

Provider First Name:

JOHN

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D., PH. D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1093899981

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/24/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

10740 PALM RIVER RD

Provider Second Line Business Mailing Address:

STE 360

Provider Business Mailing Address City Name:

TAMPA

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33619-4578

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

602-406-4786

Provider Business Mailing Address Fax Number:

916-636-4358

Provider First Line Business Practice Location Address:

625 N 6TH ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PHOENIX

Provider Business Practice Location Address State Name:

AZ

Provider Business Practice Location Address Postal Code:

85004-2155

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

602-406-8222

Provider Business Practice Location Address Fax Number:

602-406-0663

Provider Enumeration Date:

10/25/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RH0000X , with the licence number:  064441 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RH0000X , with the licence number: MD431888 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RH0000X , with the licence number: ME147761 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207RH0003X , with the licence number: 55891 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: P00925246 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 119627 . This is a "ALABAMA MEDICAID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 52497585 001 . This is a "BCBS/GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 2756281 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 602-01627 . This is a "BCBS/AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 1019279400001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1840102000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 304832075A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 114028800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".