Provider Demographics
NPI:1083606669
Name:PACANOWSKI, JOHN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:PACANOWSKI
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:3709 N CAMPBELL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1563
Mailing Address - Country:US
Mailing Address - Phone:520-838-2138
Mailing Address - Fax:520-749-0504
Practice Address - Street 1:2404 E RIVER RD BLDG 2
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6520
Practice Address - Country:US
Practice Address - Phone:520-882-7117
Practice Address - Fax:520-838-2238
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ310872086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH80783Medicare UPIN
AZZ73565Medicare ID - Type Unspecified