Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 31087 | AZ |
NPI | 1083606669 |
---|---|
Provider Name | Dr. John Paul Pacanowski |
First Address | Tucson, AZ 85719-1563 |
Second Address | Tucson, AZ 85718-6520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H80783 | (02) | AZ |