Provider Demographics
NPI:1093899981
Name:PAWLOSKI, JOHN (MD, PH D)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PAWLOSKI
Suffix:
Gender:M
Credentials:MD, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10740 PALM RIVER RD
Mailing Address - Street 2:STE 360
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4578
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:625 N 6TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2155
Practice Address - Country:US
Practice Address - Phone:602-406-8222
Practice Address - Fax:602-406-0663
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA064441207RH0000X
PAMD431888207RH0000X
FLME147761207RH0000X
AZ55891207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00925246OtherRR MEDICARE
AL119627OtherALABAMA MEDICAID
GA52497585 001OtherBCBS/GA
OH2756281Medicaid
AL602-01627OtherBCBS/AL
PA1019279400001Medicaid
WV1840102000Medicaid
GA304832075AMedicaid
AL602-01627OtherBCBS/AL
NCH41138Medicare UPIN
P00925246OtherRR MEDICARE
NC89129KGMedicare ID - Type Unspecified
PA1019279400001Medicaid
2021I14257Medicare PIN