Provider Demographics
NPI:1922378330
Name:CAGAANAN, JOHN PAUL (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:CAGAANAN
Suffix:
Gender:M
Credentials:CRNA
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 650426
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0426
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:13601 PRESTON RD
Practice Address - Street 2:STE 1000W
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4911
Practice Address - Country:US
Practice Address - Phone:972-663-8523
Practice Address - Fax:972-663-8329
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX088835367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8901UCOtherBCBS
TXP01069384OtherRAILROAD
TX290277702Medicaid
TX290277703Medicaid
TX8901UCOtherBCBS
TX290277703Medicaid