Provider Demographics
NPI:1346236544
Name:PAWLOWSKI, JEFFREY (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:PAWLOWSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6104 E BROWN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4953
Mailing Address - Country:US
Mailing Address - Phone:480-219-4100
Mailing Address - Fax:877-258-1138
Practice Address - Street 1:6104 E BROWN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4953
Practice Address - Country:US
Practice Address - Phone:480-219-4100
Practice Address - Fax:877-258-1138
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0433213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ480032937OtherMEDICARE RAILROAD
AZAZ0194390OtherBLUE CROSS BLUE SHIELD
AZ385634Medicaid
AZZ68002Medicare PIN
AZ480032937OtherMEDICARE RAILROAD
AZ385634Medicaid
AZZ68001Medicare PIN