Provider Demographics
NPI:1437228624
Name:ZUBRO, JOHN PAUL (FNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:ZUBRO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:910 E HOUSTON ST
Practice Address - Street 2:STE 330
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8368
Practice Address - Country:US
Practice Address - Phone:903-525-7995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA564692363LF0000X
TX772582363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8951NAOtherBCBS BLUE
TXP012416391OtherRAIL ROAD
TX75-2616977-001OtherTRICARE
TX203778005Medicaid
TX75-0818167-022OtherTRICARE
TX203778002Medicaid
TX291090YNSXMedicare PIN
TX291090YMAFMedicare PIN
TX8951NAOtherBCBS BLUE
TX75-0818167-022OtherTRICARE