Provider Demographics
NPI:1023007580
Name:PUND, JOHN L (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:PUND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 MAYFIELD RD
Mailing Address - Street 2:STE 450
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2270
Mailing Address - Country:US
Mailing Address - Phone:440-312-3845
Mailing Address - Fax:440-312-7171
Practice Address - Street 1:6801 MAYFIELD RD
Practice Address - Street 2:STE 450
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2270
Practice Address - Country:US
Practice Address - Phone:440-312-3845
Practice Address - Fax:440-312-7171
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-000409363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000336124OtherANTHEM
OHP00204417OtherRAILROAD MEDICARE
OHS67996Medicare UPIN
OHPA77771Medicare ID - Type Unspecified