Provider Demographics
NPI:1639270754
Name:PAGAN, JOHN A (MS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:PAGAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 DENALI STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:907-689-7946
Mailing Address - Fax:907-272-4463
Practice Address - Street 1:2600 DENALI STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-689-7946
Practice Address - Fax:907-272-4463
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist