Provider Demographics
NPI:1407928468
Name:CAHAK, JOHN (CMRT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CAHAK
Suffix:
Gender:M
Credentials:CMRT
Other - Prefix:
Other - First Name:ADVANTECH XRAY
Other - Middle Name:
Other - Last Name:IMAGING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMRT
Mailing Address - Street 1:PO BOX 22074
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-2074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:621 S RUIDOSO DOWNS
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706
Practice Address - Country:US
Practice Address - Phone:254-744-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22778247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY #
TXP00069563OtherMEDICARE RAILROAD PROVIDE
TX068124OtherAM REGISTRY OF RADIOLOGIC