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NPI Code Detail

MEDICARE: MR. JOHN MICHAEL PAUZAUSKIE CRNA

MEDICARE: MR. JOHN MICHAEL PAUZAUSKIE CRNA
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
1367500000XCertified Registered Nurse Anesthetist709721TX
2367500000XCertified Registered Nurse Anesthetist067454MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
184586UOTHERTXBCBSTX

General Provider Information

NPI Number : 1942203658
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN MICHAEL PAUZAUSKIE CRNA
Provider Business Mailing Address
First Line : 700 MARVIN HANCOCK DR
Second Line : APT 5
City : JASPER
State : TX
Zip : 75951-4756
Country : US
Telephone Number : 409-489-9686
Fax Number :
Provider Business Practice Location Address
First Line : 1275 MARVIN HANCOCK DR
Second Line :
City : JASPER
State : TX
Zip : 75951-4935
Country : US
Telephone Number : 409-384-5461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 10/29/2007

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