Healthcare Provider Details

I. General information

NPI: 1093899981
Provider Name (Legal Business Name): JOHN PAWLOSKI M.D., PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N 6TH ST
PHOENIX AZ
85004-2155
US

IV. Provider business mailing address

10740 PALM RIVER RD STE 360
TAMPA FL
33619-4578
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-8222
  • Fax: 602-406-0663
Mailing address:
  • Phone: 602-406-4786
  • Fax: 916-636-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number064441
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberMD431888
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME147761
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number55891
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: