Provider Demographics
NPI:1013953959
Name:JOHN P DZIK DO PA
Entity Type:Organization
Organization Name:JOHN P DZIK DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DZIK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:806-622-2725
Mailing Address - Street 1:PO BOX 7391
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79114-7391
Mailing Address - Country:US
Mailing Address - Phone:806-622-2725
Mailing Address - Fax:806-352-4887
Practice Address - Street 1:8745 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-6042
Practice Address - Country:US
Practice Address - Phone:806-622-2725
Practice Address - Fax:806-352-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181168901Medicaid
TX181168901Medicaid
TXDE7685Medicare PIN
TX00W545Medicare PIN