Provider Demographics
NPI:1326086778
Name:MUCHA, JOHN D (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:MUCHA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-0006
Mailing Address - Fax:713-790-6617
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-0006
Practice Address - Fax:713-790-6617
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2012-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA04631363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204590802Medicaid
TX8Y0410OtherBCBS
TXP01078375OtherRR MEDICARE
TX1326086778OtherBLUE CROSS BLUE SHIELD
TX1326086778OtherBLUE CROSS BLUE SHIELD
TX8Y0410OtherBCBS
TXTXB134842Medicare PIN