Provider Demographics
NPI:1477559391
Name:TUAZON, PAULITO D (MD)
Entity Type:Individual
Prefix:
First Name:PAULITO
Middle Name:D
Last Name:TUAZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:1504 10TH ST
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1899
Practice Address - Country:US
Practice Address - Phone:309-281-2350
Practice Address - Fax:309-281-2359
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036064838208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
020304OtherHEALTH ALLIANCE
90815OtherWELLMARK HEALTH PLANS
IL01F8OtherJOHN DEERE HEALTH PLANS
IL036064838Medicaid
143577OtherIOWA HEALTH SOLUTIONS
F85195Medicare UPIN
IL01F8OtherJOHN DEERE HEALTH PLANS