Provider Demographics
NPI:1740286665
Name:PSUTKA, JOHN FRANCIS (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANCIS
Last Name:PSUTKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2135
Mailing Address - Street 2:12302 F.M. 121 WEST
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-2135
Mailing Address - Country:US
Mailing Address - Phone:903-482-5181
Mailing Address - Fax:903-482-1290
Practice Address - Street 1:12302 F.M. 121 W.
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-2135
Practice Address - Country:US
Practice Address - Phone:903-482-5181
Practice Address - Fax:903-482-1290
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00CL012Medicaid
TXP00CL012Medicaid
TXB25676Medicare UPIN