MEDICARE: JOHN J PAPE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	48125	WI
2	2085R0202X	Diagnostic Radiology Physician	36876	IA
3	2085R0202X	Diagnostic Radiology Physician	49207	MN
4	2085R0202X	Diagnostic Radiology Physician	MD2018-0036	NM

General Provider Information

NPI Number	:	1710982947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J PAPE MD

Provider Business Mailing Address
First Line	:	1400 MAIN ST. SW
Second Line	:	SUITE K
City	:	LOS LUNAS
State	:	NM
Zip	:	87031
Country	:	US
Telephone Number	:	505-916-5912
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 MAIN ST. SW
Second Line	:	SUITE K
City	:	LOS LUNAS
State	:	NM
Zip	:	87031
Country	:	US
Telephone Number	:	505-916-5912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	09/13/2018

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