MEDICARE: DR. JOHN PAUL PACANOWSKI 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	2086S0129X	Vascular Surgery Physician	31087	AZ

General Provider Information

NPI Number	:	1083606669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PAUL PACANOWSKI MD

Provider Business Mailing Address
First Line	:	3709 N CAMPBELL AVE STE 201
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-1563
Country	:	US
Telephone Number	:	520-838-2138
Fax Number	:	520-749-0504

Provider Business Practice Location Address
First Line	:	2404 E RIVER RD BLDG 2
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-6520
Country	:	US
Telephone Number	:	520-882-7117
Fax Number	:	520-838-2238

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	03/17/2018

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